Administrative Data

The 30-day Hospital-Wide, All-Cause Unplanned Readmission (HWR) Rate for the Merit-based Incentive Payment System (MIPS) Groups measure is a risk-standardized readmission rate for beneficiaries age 65 or older who were hospitalized and experienced an unplanned readmission for any cause to a short-stay acute-care hospital within 30 days of discharge. The measure attributes readmissions to up to three MIPS participating clinician groups, as identified by their Medicare Taxpayer Identification Number (TIN), and assesses each group’s readmission rate.

Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data measures facility-level risk-standardized rate of readmission (RSRR) within 30 days of discharge from an inpatient admission, among Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients aged 65 years and older. 

Hybrid Hospital-Wide (All-Condition, All-Procedure) Risk-Standardized Mortality Measure with Claims and Electronic Health Record Data measure estimates a hospital-level 30-day risk-standardized mortality rate (RSMR), defined as death from any cause within 30 days after the index admission date for Medicare fee-for-service and Medicare Advantage patients who are between the ages of 65 and 94. 

The percentage of individuals ≥18 years of age with ≥1 initial opioid prescriptions for >7 cumulative days’ supply during the measurement year.

Percentage of enrolled children under age 21 years who received a comprehensive or periodic oral evaluation within the reporting year.

The primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) complication measure assesses risk-standardized complication rates (RSCRs) for individual clinicians or groups of clinicians to improve the quality of care delivered to their patients.  

This re-specified measure includes THA/TKA procedures performed in both inpatient and outpatient (hospital outpatient department and Ambulatory Surgery Centers [ASC]) settings among eligible Medicare Fee-For-Service (FFS) beneficiaries who are at least 65 years of age. 

This is a measure of follow-up clinical visits for patients with chronic conditions who have experienced an acute exacerbation of one of six conditions (eight categories) of interest (coronary artery disease [CAD] {high or low acuity}, hypertension {high or medium acuity}, heart failure [HF], diabetes, asthma, and chronic obstructive pulmonary disease [COPD]) and are among adult Medicare Fee-for-Service (FFS) beneficiaries who are attributed to entities participating in the CMMI Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) model.

This measure identifies moderate and severe complications among term infants who enter labor without preexisting fetal conditions (morbidity outcome measure).  The scope of the measure includes both maternal and neonatal care and is appropriate for all levels of hospital care and is collected for a full year time period.  The measure is designed to highlight processes of both obstetric and neonatal care that can be improved while recognizing that not all complications can be avoided.  As an infant outcome measure it can also serve as a balancing measure for interventions targ