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February 19, 2003

Risk of Cutaneous Vaccinia From Health Care Workers Who Receive Smallpox Vaccine

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(7):845-847. doi:10.1001/jama.289.7.845-a

In Reply: Ms Ignagni and Dr Pawlson criticize us for using older HEDIS data. At the time our study was submitted in June 2001, NCQA had released neither HEDIS 2001 nor 2002. Moreover, we doubt that inclusion of more recent data would substantially alter our conclusions.

According to Pawlson, the percentage of plans withdrawing from public disclosure declined in 2001 and 2002. He lauds a 1999 NCQA policy change that required public disclosure for plans newly seeking formal accreditation. While we applaud this policy, it scarcely resolves the problem because accreditation remains optional. Low-scoring plans can still manipulate the process by forgoing accreditation or by withdrawing from HEDIS altogether. Hence, the actual proportion of plans whose scores are hidden from public view is far higher than Pawlson and Ignagni suggest. While the dropout rate has been lower in the past 2 years, the percentage of plans that submitted HEDIS scores to NCQA but refused public disclosure was still 27% in 2001 and 18% in 2002 (written communication, Communications Department, NCQA, December 10, 2002). Moreover, in 2002, only 336 of the 500 HMOs listed in the InterStudy HMO Directory1 submitted HEDIS scores to the NCQA, and 62 of these refused to allow public disclosure of their scores (written communication, Communications Department, NCQA, December 10, 2002). Thus, only 55% (274/500) of HMOs in the United States disclosed quality data.