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Medicare Shared Savings Program (MSSP)

Falls: Screening, Risk-Assessment, and Plan of Care to Prevent Future Falls

  • This is a clinical process measure that assesses falls prevention in older adults. The measure has three rates:

    A) Screening for Future Fall Risk:
    Percentage of patients aged 65 years and older who were screened for future fall risk at least once within 12 months



    B) Falls Risk Assessment: 
    Percentage of patients aged 65 years and older with a history of falls who had a risk assessment for falls completed within 12 months

    C) Plan of Care for Falls: 

    CBE ID
    0101

Hospital-Wide All-Cause Unplanned Readmission Measure (HWR)

  • This measure estimates a hospital-level, risk-standardized readmission rate (RSRR) of unplanned, all-cause readmission within 30 days of discharge from an index admission with an eligible condition or procedure. The measure reports a single summary RSRR, derived from the volume-weighted results of five different models, one for each of the following specialty cohorts based on groups of discharge condition categories or procedure categories: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology.

    CBE ID
    3656

Hospital-Wide All-Cause Unplanned Readmission Measure (HWR)

  • This measure estimates a hospital-level, risk-standardized readmission rate (RSRR) of unplanned, all-cause readmission within 30 days of discharge from an index admission with an eligible condition or procedure. The measure reports a single summary RSRR, derived from the volume-weighted results of five different models, one for each of the following specialty cohorts based on groups of discharge condition categories or procedure categories: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology.

    CBE ID
    1789

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet

  • The percentage of patients 18 years of age and older who were discharged from an inpatient setting with an acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) during the 12 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of routine use of aspirin or another antiplatelet during the measurement year.

    CBE ID
    0068

Preventive Care and Screening: Influenza Immunization

  • Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

    CBE ID
    0041

Preventive Care and Screening: Screening for Depression and Follow-Up Plan

  • Percentage of patients aged 12 years and older screened for depression on the date of the encounter or 14 days prior to the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter

    CBE ID
    0418

Preventive Care and Screening: Screening for Depression and Follow-Up Plan

  • Percentage of patients aged 12 years and older screened for depression on the date of the encounter or 14 days prior to the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the eligible encounter

    CBE ID
    0418e

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

  • Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

    Three rates are reported:
    a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months
    b. Percentage of patients aged 18 years and older who were identified as a tobacco user who received tobacco cessation intervention

    CBE ID
    0028

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

  • Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

    Three rates are reported:
    a. Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months
    b. Percentage of patients aged 18 years and older who were screened for tobacco use and identified as a tobacco user who received tobacco cessation intervention

    CBE ID
    0028e