Payment Program

Percentage of patients aged 18 years and older with a diagnosis of nonvalvular atrial fibrillation (AF) or atrial flutter whose assessment of the specified thromboembolic risk factors indicate one or more high-risk factors or more than one moderate risk factor, as determined by CHADS2 risk stratification, who are prescribed warfarin OR another oral anticoagulant drug that is FDA approved for the prevention of thromboembolism

For patients age 18 and older undergoing lumbar spine fusion surgery, the average change from pre-operative functional status to one year (nine to fifteen months) post-operative functional status using the Oswestry Disability Index (ODI version 2.1a) patient reported outcome tool.

Percentage of adult in-center hemodialysis patients in the facility whose average ultrafiltration rate (UFR) is >=13 ml/kg/hour AND who receive an average of <240 minutes per treatment during the calculation period.

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).

Percentage of patients at least 18 years of age and younger than 80 with back pain who have received an epidural steroid injection in the absence of radicular pain AND those patients with radicular pain who received an epidural steroid injection without image guidance (i.e. overuse measure, lower performance is better).

Percentage of patients at least 18 years of age and younger than 80 with a diagnosis of back pain who have medical record documentation of all of the following on the date of the initial visit to the physician:
1. Pain assessment
2. Functional status
3. Patient history, including notation of presence or absence of “red flags”
4. Assessment of prior treatment and response, and
5. Employment status

Percentage of patients at least 18 years of age and younger than 80 with back pain with documentation that the physician conducted reassessment of both of the following within four to six weeks of their initial back pain visit or of a surgical procedure date:
1) Pain AND
2) Functional status

Percentage of patients at least 18 years of age and younger than 80 with a back pain episode of 28 days or more with documentation of a physical examination on the date of the initial visit with the physician.