Maintenance

Total Cost of Care reflects a mix of complicated factors such as patient illness burden, service utilization and negotiated prices. Total Cost Index (TCI) is a measure of a primary care provider’s risk adjusted cost effectiveness at managing the population they care for. TCI includes all costs associated with treating members including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services.

The Total Per Capita Cost (TPCC) measure assesses the overall cost of care delivered to a beneficiary with a focus on the primary care they receive from their provider(s). The TPCC measure score is a clinician’s average risk-adjusted and specialty-adjusted cost across all beneficiary months attributed to the clinician during a one year performance period.

The Resource Use Index (RUI) is a risk adjusted measure of the frequency and intensity of services utilized to manage a provider group’s patients. Resource use includes all resources associated with treating members including professional, facility inpatient and outpatient, pharmacy, lab, radiology, ancillary and behavioral health services.

A Resource Use Index when viewed together with the Total Cost of Care measure (NQF-endorsed #1604) provides a more complete picture of population based drivers of health care costs.

Documentation of the extent to which a provider uses a certified/qualified electronic health record (EHR) system to track pending laboratory tests, diagnostic studies (including common preventive screenings) or patient referrals. The Electronic Health Record includes provider reminders when clinical results are not received within a predefined timeframe.

The percentage of children ages 2 through 15 years old with sickle cell anemia (Hemoglobin SS) who received at least one transcranial Doppler (TCD) screening within a year.

The number of medical and surgical discharges with a secondary diagnosis of transfusion reaction for patients ages 17 years and younger. Excludes cases with a principal diagnosis of transfusion reaction, cases with a secondary diagnosis of transfusion reaction that is present on admission, neonates, and obstetric cases.

The number of medical and surgical discharges with a secondary diagnosis of transfusion reaction for patients ages 18 years and older or obstetric patients. Excludes cases with a principal diagnosis of transfusion reaction or cases with a secondary diagnosis of transfusion reaction that is present on admission.

Percentage of discharges from an emergency department (ED) to ambulatory care or home health care, in which the patient, regardless of age, or their caregiver(s), received a transition record at the time of ED discharge including, at a minimum, all of the specified elements

Percentage of female patients aged 18 and over with HER2/neu positive invasive breast cancer who are administered trastuzumab

Emergency Department acute myocardial infarction (AMI) patients or chest pain patients (with Probable Cardiac Chest Pain) with an order for troponin during the stay and having a time from ED arrival to completion of Troponin results within 60 minutes of arrival