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This measure estimates the risk-standardized rate of unplanned, all-cause readmissions for patients (Medicare fee-for-service [FFS] beneficiaries) discharged from an Inpatient Rehabilitation Facility (IRF) who were readmitted to a short-stay acute-care hospital or a Long-Term Care Hospital (LTCH), within 30 days of an IRF discharge. The measure is based on data for 24 months of IRF discharges to non-hospital post-acute levels of care or to the community.

A risk-adjusted readmission rate for each facility is calculated as follows:

This measure estimates the risk-standardized rate of unplanned, all-cause readmissions for patients (Medicare fee-for-service [FFS] beneficiaries) discharged from a Long-Term Care Hospital (LTCH) who were readmitted to a short-stay acute-care hospital or a Long-Term Care Hospital (LTCH), within 30 days of an LTCH discharge. The measure is based on data for 24 months of LTCH discharges to non-hospital post-acute levels of care or to the community.

A risk-adjusted readmission rate for each facility is calculated as follows:

The percentage of members 18 years of age and older who were treated antidepressant medication, had a diagnosis of major depression, and who remained on an antidepressant medication treatment. Two rates are reported.

a) Effective Acute Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). 
b) Effective Continuation Phase Treatment. The percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).

To ensure that all members diagnosed with HIV receive at least annual testing for CD4 and at least biannual HIV RNA levels to monitor for disease activity.

The percentage of ED patients with a diagnosis of STEMI who received appropriate and timely treatment. The measure will be calculated using electronic health record (EHR) data and is intended for use at the facility level in a CMS accountability program, through which it may be publicly reported.

Admissions with a principal diagnosis of asthma per 100,000 population, ages 2 through 17 years. Excludes cases with a diagnosis code for cystic fibrosis and anomalies of the respiratory system, obstetric admissions, and transfers from other institutions.

[NOTE: The software provides the rate per population. However, common practice reports the measure as per 100,000 population. The user must multiply the rate obtained from the software by 100,000 to report admissions per 100,000 population.]

Percentage of patients, age >=18 and <= 120 at diagnosis, who have their first diagnosis of cancer (epithelial malignancy), whose primary tumor is of the colon, and had at least 12 regional lymph nodes removed and pathologically examined for resected colon cancer

Percentage of patients at least 18 years of age and younger than 80 with a back pain episode of 28 days or more with medical record documentation that a physician advised them against bed rest lasting four days or longer.

Percentage of patients at least 18 years of age and younger than 80 with a back pain episode of 28 days or more with medical record documentation that a physician advised them to maintain or resume normal activities.

Percentage of patients at least 18 years of age and younger than 80 with a diagnosis of back pain for whom the physician ordered imaging studies during the six weeks after pain onset, in the absence of “red flags” (overuse measure, lower performance is better).