The Centers for Medicare & Medicaid Services (CMS), through Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation (CORE), has developed claims-based hospital measures to assess the quality of care provided to Medicare beneficiaries by clinicians or clinician groups who are eligible to participate under the Merit-based Incentive Payment System (MIPS). AAHKS was represented on the Work Group, which sought to “re-specify (or adapt) two hospital quality measures for the measurement of clinicians or clinician groups,” including the Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty.

A listening session about the measures will be held on December 11, 2018 from 6:00 to 7:00 p.m. (EST). Register for webinar information.

Comments on the THA/TKA complication measure are due January 4, 2019. AAHKS is developing a comment letter, which we will share with members to assist with your feedback. We encourage all members to provide comments directly to CMS, in addition to our organizational letter.  

Information from CMS

Draft Measure and Methodology Report for Review

Project Title: Development of Inpatient Outcome Measures for the Merit-based Incentive Payment System
Dates: The Call for Public Comment period opens on November 29, 2018 and closes on January 4, 2019.
Project Overview: The Centers for Medicare & Medicaid Services (CMS) has contracted with Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation (CORE) to adapt claims-based hospital measures to assess the quality of care provided to Medicare beneficiaries by clinicians or clinician groups who are eligible to participate under the Merit-based Incentive Payment System (MIPS). The contract name is Development, Reevaluation, and Implementation of Hospital Outcome/Efficiency Measures for Hospital and Eligible Clinicians. The contract number is HHSM-500-2013-13018I, Task Order HHSM-500-T0001.

The primary goal of this project is to re-specify (or adapt) two hospital quality measures for the measurement of clinicians or clinician groups. The two measures CORE is re-specifying are the:

  1. Hospital-Wide All-Cause Unplanned Readmission Measure (hereafter “HWR measure”).
  2. Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (hereafter “THA/TKA complication measure”).

The re-specified measures will assess each eligible clinician or clinician group’s readmission or complication rate, respectively, relative to that of other MIPS participating clinicians or clinician groups with similar patients. One measure, HWR, is already in use in the MIPS; this is an updated re-specification. The quality measure scores will be calculated using patient characteristics and outcomes documented on routinely submitted Medicare claims; therefore, the MIPS eligible clinicians or clinician groups whose performance will be assessed by the quality measures will not need to submit any additional data directly to CMS.

Project Objectives:

The primary goal of this project is to gather expert and stakeholder input to inform quality measure development for patients with a range of acute and/or chronic conditions, or patients undergoing elective procedures. CMS will use the measures to evaluate the quality of care provided by MIPS eligible clinicians or clinician groups.

Documents and Measures for Comment:

The following documents are provided for your review and comment. The files are found below in the Download section.

  1. For the HWR measure: “Measure Methodology Report for Public Comment: Clinician and Clinician Group Hospital-wide All-cause Unplanned Readmission Measure,” which presents the approach to measure development, measure specifications, and results of measure testing.
  2. For the THA/TKA complication measure: “Measure Methodology Report for Public Comment: Clinician and Clinician Group Risk-Standardized Complication Rate Following Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty,” which presents the approach to measure development, measure specifications, and results of measure testing

Project Specific Instructions:

Comments may be submitted electronically:

  • CMS encourages you to submit comments electronically on one or both of the measures under development.
    • If you are providing comments on behalf of an organization, please include the organization’s name and your contact information.
    • If you are commenting as an individual, please submit identifying or contact information.
  • Send your comments to CMSinpatientMIPSmeasures@yale.edu by 11:59 PM Eastern Standard Time on January 4, 2019.
    • Any attachments should be in Microsoft Word, Excel, or PDF format.
    • Please do not include personal health information (for example, date of birth, social security number, health insurance claim number) in your comment.
  • At the end of the public comment period, all public comments will be posted on this website.

CORE will also host listening sessions via webinar during the call for public commentThe listening sessions are an opportunity for stakeholders to learn about and provide feedback on the re-specified measures. The target audience for the listening sessions includes clinicians who provide care to Medicare beneficiaries, especially those included in one or the other measure, as well as organizations representing these clinicians and other interested stakeholders.

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