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Cost and Efficiency

Cost and Efficiency

Resource use measures are measures that capture the amount or frequency of health services applied to a population or event (e.g., procedures, encounters). A resource use measure may apply a dollar amount (e.g., allowable charges, paid amounts, or standardized prices) to a resource unit. As health care expenditures continue to grow, it is crucial to understand how resources are utilized to maximize quality in the health care system. Health care cost measurement continues to be a critical component in assessing the United States (U.S.) health care system. Measures in the Cost, Resource Use, and Efficiency portfolio are essential to evaluate the efficiency of care (i.e., higher quality, lower cost) and improve value through changes in practice. Improving U.S. health system efficiency can simultaneously reduce cost growth and improve the quality of care provided.

This committee considers measures that focus on total health care spending for a health care service or group of services associated with a specified patient population, time period, and/or unit of clinical accountability. Measures in this topic area include admission, readmission, and emergency department utilization. Others include broadly focused measures, such as per capita measures, which address total health care spending or resource use per person, and narrowly focused measures, such as measures dealing with the health care spending or resource use of an individual procedure (e.g., a hip replacement). 

 

Committee Roster

Measures

Project

Measures

CBE ID Title Steward New / Maintenance Previous Endorsement Cycle Next Maintenance Cycle Endorsement Status
2539 Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy Centers for Medicare & Medicaid Services Maintenance Spring 2024 Spring 2029 Endorsed with Conditions
3495 Hospital-Wide 30-Day, All-Cause, Unplanned Readmission Rate (HWR) for the Merit-Based Incentive Payment System (MIPS) Eligible Clinician Groups Centers for Medicare & Medicaid Services Maintenance Spring 2024 Spring 2029 Endorsed with Conditions
4490 Hospitalizations for Ambulatory Care Sensitive Conditions among Home and Community Based Service (HCBS) Participants Centers for Medicare & Medicaid Services New Spring 2024 Spring 2029 Endorsed with Conditions
0495 Median Time from ED Arrival to ED Departure for Admitted ED Patients Centers for Medicare & Medicaid Services Maintenance Fall 2018 Endorsement Removed
0496 Median Time from ED Arrival to ED Departure for Discharged ED Patients Centers for Medicare & Medicaid Services Maintenance Fall 2020 Endorsement Removed
0497 Admit Decision Time to ED Departure Time for Admitted Patients Centers for Medicare & Medicaid Services Maintenance Fall 2018 Endorsement Removed
1598 Total Resource Use Population-based PMPM Index HealthPartners Maintenance Spring 2021 Spring 2025 Endorsed
1604 Total Cost of Care Population-based PMPM Index HealthPartners Maintenance Spring 2021 Spring 2025 Endorsed
1609 ETG Based HIP/KNEE REPLACEMENT cost of care measure Optum Maintenance Fall 2018 Endorsement Removed
2158 Medicare Spending Per Beneficiary (MSPB) - Hospital Centers for Medicare & Medicaid Services Maintenance Fall 2020 Fall 2024 Endorsed
Final Reports

Media

Final Reports

Materials

Materials

Materials