Outcome-Focused

This measure is a re-specified version of the measure, “Hospital-level risk-standardized complication rate (RSCR) following elective primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA)” (NQF 1550), which was developed for patients 65 years and older using Medicare claims data.

This measure estimates a hospital -level risk standardized survival rate (RSSR) for patients aged 18 years and older who experience an in-hospital cardiac arrest.

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.

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.

This measure assesses the extent to which health care providers actually involve patients in a decision-making process when there is more than one reasonable option. This proposal is to focus on patients who have undergone any one of 7 common, important surgical procedures: total replacement of the knee or hip, lower back surgery for spinal stenosis of herniated disc, radical prostatectomy for prostate cancer, mastectomy for early stage breast cancer or percutaneous coronary intervention (PCI) for stable angina.

The SNFRM estimates the risk-standardized rate of all-cause, unplanned hospital readmissions for Skilled Nursing Facility (SNF) Medicare fee-for-service (FFS) beneficiaries within 30 days of discharge from a prior proximal acute hospitalization. The prior proximal hospitalization is defined as an admission to an IPPS, CAH, psychiatric, or cancer hospital. The measure is risk-adjusted for patient demographics, principal diagnosis from the prior hospitalization, comorbidities, and other health status variables that affect the probability of a hospital readmission.

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.

Standardized mortality ratio is defined to be the ratio of the number of deaths that occur for Medicare ESRD dialysis patients treated at a particular facility to the number of deaths 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.