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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). 

Measures

Project

Measures

CBE ID Title Sort descending Steward Submission Type E&M Cycle
2579 Hospital-level, risk-standardized payment associated with a 30-day episode of care for pneumonia (PN) Centers for Medicare & Medicaid Services Maintenance Spring 2021
2431 Hospital-level, risk-standardized payment associated with a 30-day episode-of-care for Acute Myocardial Infarction (AMI) Centers for Medicare & Medicaid Services Maintenance Spring 2021
2436 Hospital-level, risk-standardized payment associated with a 30-day episode-of-care for heart failure (HF) Centers for Medicare & Medicaid Services Maintenance Spring 2021
3474 Hospital-level, risk-standardized payment associated with a 90-day episode of care for elective primary total hip and/or total knee arthroplasty (THA/TKA) Centers for Medicare & Medicaid Services Maintenance Fall 2023
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
4490 Hospitalizations for Ambulatory Care Sensitive Conditions among Home and Community Based Service (HCBS) Participants Centers for Medicare & Medicaid Services New Spring 2024
3512 Knee Arthroplasty Centers for Medicare & Medicaid Services Maintenance
3626 Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels Measure Centers for Medicare & Medicaid Services Maintenance Spring 2022
0495 Median Time from ED Arrival to ED Departure for Admitted ED Patients Centers for Medicare & Medicaid Services Maintenance Fall 2018
0496 Median Time from ED Arrival to ED Departure for Discharged ED Patients Centers for Medicare & Medicaid Services Maintenance Fall 2020
Final Reports

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