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Cost, Resource Use, and Efficiency

Valid for Measure Submission

E&M Spring 2024 Cost and Efficiency Endorsement Meeting

The purpose of this meeting is for Recommendation Group members to discuss and share perspectives regarding the measures under endorsement review for their respective E&M committee. Endorsement voting occurs during these virtual meetings. Advisory Group members are invited to attend these Recommendation Group meetings to listen to the discussion. Measure developers/stewards are invited and encouraged to attend, as they will have the opportunity to respond to the Recommendation Group discussion during the meeting.

Elective Primary Hip Arthroplasty Measure

The Elective Primary Hip Arthroplasty episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for patients who receive an elective primary hip arthroplasty during the performance period. The measure score is a clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician.

CBE ID
3623

ETG Based HIP/KNEE REPLACEMENT cost of care measure

The measure focuses on resources used to deliver episodes of care for patients who have undergone a Hip/Knee Replacement. Hip Replacement and Knee Replacement episodes are initially defined using the Episode Treatment Groups (ETG) methodology and describe the unique presence of the condition for a patient and the services involved in diagnosing, managing and treating the condition. The Procedure Episode Group (PEG) methodology uses the ETG results and further logic to creating a procedure episode that focuses on the Hip Replacement and Knee Replacement component of the care.

CBE ID
1609

ETG Based PNEUMONIA cost of care measure

The measure focuses on resources used to deliver episodes of care for patients with pneumonia. Pneumonia episodes are defined using the Episode Treatment Groups (ETG) methodology and describe the unique presence of the condition for a patient and the services involved in diagnosing, managing and treating pneumonia. A number of resource use measures are defined for pneumonia episodes, including overall cost of care, cost of care by type of service, and the utilization of specific types of services.

CBE ID
1611

Excess days in acute care (EDAC) after hospitalization for acute myocardial infarction (AMI)

The Excess Days in Acute Care (EDAC) after Hospitalization for Acute Myocardial Infarction (AMI) (hereafter “AMI EDAC") measure assesses days spent in acute care within 30 days of discharge from an inpatient hospitalization for AMI. This measure is intended to improve the quality of care transitions provided to discharged patients hospitalized for AMI by collectively measuring a set of adverse acute care outcomes that can occur post-discharge: emergency department (ED) visits, observation stays, and unplanned readmissions at any time during the 30 days post-discharge.

CBE ID
2881

Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy

This measure was developed to improve the quality of care delivered to patients undergoing outpatient colonoscopy procedures. The Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy Measure, estimates a facility-level rate of risk-standardized, all-cause, unplanned hospital visits within seven days of a colonoscopy procedure performed at a hospital outpatient department (HOPD) or ambulatory surgical center (ASC) among Medicare Fee-for-Service (FFS) patients aged 65 years and older.

CBE ID
2539

Facility-Level 7-Day Hospital Visits after General Surgery Procedures Performed at Ambulatory Surgical Centers

This measure was developed to improve the quality of care delivered to patients undergoing general surgery procedures in an ambulatory surgical center (ASC). To assess quality, the measure calculates the risk-standardized rate of return to a hospital for an acute, unplanned hospital visit within seven days of qualified general surgery procedures performed at an ambulatory surgical center (ASC) among Medicare Fee-For-Service (FFS) patients aged 65 years and older.

CBE ID
3357

Hospital 30-Day Risk-Standardized Readmission Rates following Percutaneous Coronary Intervention (PCI)

This measure estimates a hospital-level risk-standardized readmission rate (RSRR) following PCI for Medicare Fee-for-Service (FFS) patients who are 65 years of age or older. The outcome is defined as unplanned readmission for any cause within 30 days following hospital stays. The measure includes both patients who are admitted to the hospital (inpatients) for their PCI and patients who undergo PCI without being admitted (outpatient or observation stay). A specified set of planned readmissions do not count as readmissions.

CBE ID
0695