Payment Program

The Routine Cataract Removal with Intraocular Lens (IOL) Implantation cost measure evaluates clinicians’ risk-adjusted cost to Medicare for beneficiaries who receive this procedure. The cost measure score is a clinician’s average risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during the 60 days prior to the clinical event that opens or ‘triggers’ the episode, through 90 days after the trigger.

Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge.

Percentage of women 65-85 years of age who ever had a central dual-energy x-ray absorptiometry (DXA) test to check for osteoporosis.

The percentage of children who received visual acuity screening at least once by their 6th birthday; and if necessary, were referred appropriately.

The Screening/Surveillance Colonoscopy cost measure evaluates clinicians’ risk-adjusted cost to Medicare for beneficiaries who receive this procedure. The cost measure score is a clinician’s average risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This procedural measure includes costs of services that are clinically related to the attributed clinician’s role in managing care from the day of the clinical event that opens or ‘triggers’ the episode, through 14 days after the trigger.

This measure focuses on adults 18 years and older with a diagnosis of severe sepsis or septic shock. Consistent with Surviving Sepsis Campaign guidelines, it assesses measurement of lactate, obtaining blood cultures, administering broad spectrum antibiotics, fluid resuscitation, vasopressor administration, reassessment of volume status and tissue perfusion, and repeat lactate measurement.

Standardized average length of hospital stay (ALOS) for routine inpatient care (i.e., care provided outside of intensive care units).

SNF HAI is a one-year outcome measure that estimates the risk-standardized rate of healthcare-associated infections (HAIs) that are acquired during SNF care and result in hospitalization.

Ratio of observed to expected major adverse events (MAE) among patients undergoing congenital cardiac catheterization, risk-adjusted using the Catheterization for Congenital Heart Disease Adjustment for Risk Method II (CHARM II).

The standardized hospitalization ratio is defined to be the ratio of the number of hospital admissions that occur for Medicare ESRD dialysis patients treated at a particular facility to the number of hospitalizations that would be expected given the characteristics of the dialysis facility’s patients and the national norm for dialysis facilities. This measure is calculated as a ratio but can also be expressed as a rate.