Claims Data

The percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) during the 12 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to measurement year, who had each of the following during the measurement year.

- Complete Lipid Profile
- LDL-C control <100 mg/dL

The percentage of patients 18 years of age and older who were discharged from an inpatient setting with an acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) during the 12 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the year prior to the measurement year and who had documentation of routine use of aspirin or another antiplatelet during the measurement year.

The Knee Arthroplasty 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 30 days prior to the clinical event that opens or ‘triggers’ the episode, through 90 days after the trigger.

This measure is used to assess the percent of patient visits and admissions where preferred spoken language for health care is screened and recorded.

This measure identifies the percentage of patients taking lithium who have had at least one creatinine test after the earliest observed lithium prescription during the measurement year.

This measure identifies the percentage of patients taking lithium who have had at least one lithium level test after the earliest observed lithium prescription during the measurement year.

This measure identifies the percentage of patients taking lithium who have had at least one thyroid function test after the earliest observed lithium prescription during the measurement year.

Low birth weight (< 2,500 grams) infants per 1,000 newborns. Excludes transfers from other institutions.

[NOTE: The software provides the rate per newborn. However, common practice reports the measure as per 1,000 newborns. The user must multiply the rate obtained from the software by 1,000 to report admissions per 1,000 newborns.]

[NOTE: This indicator can be calculated in SAS QI Software Version 4.5 using either the PDI Module or the PQI #9 Standalone Module.]

Admissions for any-listed diagnosis of diabetes and any-listed procedure of lower-extremity amputation (except toe amputations) per 100,000 population, ages 18 years and older. Excludes any-listed diagnosis of traumatic lower-extremity amputation admissions, 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.]

The Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for patients who undergo surgery for lumbar spine fusion during the performance period. The measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician.