All The Hospital CMS Measures that Impact Star Rating, VBP, HRRP & HAC Programs


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All CMS Measures at a Glance

CMS has come up with different programs to improve health outcomes by focusing on improving various aspects of the healthcare system. Dexur’s data provides in-depth information on the metrics of different programs such as CMS Star Ratings, VBP, HRRP, and HAC. While hospitals have to wait for more than a year to get this data from CMS, Dexur replicates CMS algorithms and updates the data at DRG levels only with a 5-6 month delay.

All CMS Measures at a Glance
Measure Category Measure Name Measure Description CMS Category CMS Star Rating Value-Based Purchasing (VBP) Hospital Readmissions Reduction Program (HRRP) Hospital-Acquired Condition (HAC) Reduction Program
Cost Effectiveness MSPB Medicare Spending Per Beneficiary
Readmissions READM-30-AMI AMI- 30-day Readmission Rate
Readmissions READM-30-HF Heart Failure- 30-day Readmission Rate
Readmissions READM-30-PN Pneumonia- 30-day Readmission Rate
Readmissions READM-30-CABG CABG - Surgery 30-day Readmission Rate Readmission
Readmissions READM-30-COPD COPD- 30-day Readmission Rate Readmission
Readmissions READM-30-Hip-Knee 30-day readmission rate following elective primary THA and/or TKA Readmission
Readmissions READM-30-HOSP-WIDE 30-day hospital-wide all- cause unplanned readmission (HWR) Readmission
Readmissions READM-30-STK (2019) Stroke -30-Day Readmission Rate Readmission

(Included in FY2019 and Excluded in FY2017, FY2020, FY2021)

Readmissions EDAC-30-AMI AMI - Excess Days in Acute Care Readmission
Readmissions EDAC-30-HF HF - Excess Days in Acute Care Readmission
Readmissions EDAC-30-PN PN - Excess Days in Acute Care Readmission
Readmissions OP-32 Facility 7-day risk standardized hospital visit rate after outpatient colonoscopy Readmission
Mortality MORT-30-AMI AMI- 30-day Mortality Rate Mortality
Mortality MORT-30-HF HF-30-day Mortality Rate Mortality
Mortality MORT-30-PN PN-30-day Mortality Rate Mortality
Mortality MORT-30-CABG CABG-30-day Mortality Rate Mortality

(Included in FY2022, FY2023, FY2024 and Excluded in FY2020, FY2021)

Mortality MORT-30-COPD COPD-30-day Mortality Rate Mortality

(Included in FY2021, FY2022, FY2023, FY2024 and Excluded in FY2020)

Mortality MORT-30-STK Stroke 30-day Mortality Rate Mortality
Mortality PSI-4-SURG-COMP Death rate among surgical inpatients with serious treatable complications Mortality
HAI/ HAC / Complications /Safety COMP-HIP-KNEE Risk-Standardized Complication Rate - Following elective primary THA and TKA Safety of Care
HAI/ HAC / Complications /Safety HAI-1 (CLABSI) CLABSI in ICUs and Select Wards Safety of Care
HAI/ HAC / Complications /Safety HAI-2 (CAUTI) CAUTI in ICUs and Select Wards Safety of Care
HAI/ HAC / Complications /Safety HAI-3 (SSI - Colon) SSI: Colon Safety of Care
HAI/ HAC / Complications /Safety HAI-4 (SI - Hysterectomy) SSI: Hysterectomy Safety of Care
HAI/ HAC / Complications /Safety HAI-5 (MRSA) MRSA - Bloodstream Infections Safety of Care
HAI/ HAC / Complications /Safety HAI-6 (C. Diff) C.diff. - Intestinal Infections Safety of Care
HAI/ HAC / Complications /Safety PSI-90-Safety Patient safety and adverse events composite Safety of Care

(Included in FY2023, FY2024 and Excluded in FY2020, FY2021, FY2022)

HCAHPS H-CLEAN-HSP Cleanliness of Hospital Environment Patient Experience
HCAHPS H-COMP-1 Communication with Nurses Patient Experience
HCAHPS H-COMP-2 Communication with Doctors Patient Experience
HCAHPS H-COMP-3 Responsiveness of Hospital Staff Patient Experience
HCAHPS H-COMP-5 Communication about Medicines Patient Experience
HCAHPS H-COMP-6 Discharge Information Patient Experience
HCAHPS H-HSP-RATING Overall Rating of Hospital Patient Experience
HCAHPS H-QUIET-HSP Quietness of Hospital Environment Patient Experience
HCAHPS H-RECMND Willingness to Recommend the Hospital Patient Experience
HCAHPS H-COMP-7 Care Transition Patient Experience
Effectiveness of Care IMM-2 Influenza immunization Effectiveness of Care

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

Effectiveness of Care IMM-3 Influenza vaccination coverage among healthcare personnel Effectiveness of Care

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

Effectiveness of Care OP-22 Left without being seen Effectiveness of Care
Effectiveness of Care OP-23 Head CT scan results for acute ischemic stroke or hemorrhagic stroke who received head CT scan interpretation within 45 minutes of arrival Effectiveness of Care
Effectiveness of Care OP-29 Appropriate follow-up interval for normal colonoscopy in average risk patients Effectiveness of Care
Effectiveness of Care OP-30 Colonoscopy interval for patients with a history of adenomatous polyps - avoidance of inappropriate use Effectiveness of Care

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

Effectiveness of Care OP-33 External beam radiotherapy for bone metastases Effectiveness of Care
Effectiveness of Care PC-01 Elective delivery prior to 39 completed weeks of gestation Effectiveness of Care
Effectiveness of Care SEP-1 Early management bundle, severe sepsis/septic shock Effectiveness of Care
Effectiveness of Care VTE-6 Hospital acquired potentially preventable venous thromboembolism Effectiveness of Care

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

Effectiveness of Care OP-4 (2019) Aspirin at Arrival Effectiveness of Care

(Included in FY2019 and Excluded in FY2017, FY2020, FY2021)

Timeliness of Care ED-1b Average (median) time patients spent in the emergency department, before they were admitted to the hospital as an inpatient A lower number of minutes is better Timeliness of Care

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

Timeliness of Care ED-2b Median time from admit decision to time of departure from the emergency department for patients admitted to inpatient status Timeliness of Care
Timeliness of Care OP-2 Fibrinolytic therapy received within 30 minutes of emergency department arrival Timeliness of Care
Timeliness of Care OP-3b Median time to transfer to another facility for acute coronary intervention Timeliness of Care
Timeliness of Care OP-5 Median Time to ECG Timeliness of Care

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

Timeliness of Care OP-18b Median time from emergency department arrival to emergency department departure for discharged patients Timeliness of Care
Timeliness of Care OP-1 (2019) Median Time to Fibrinolysis Timeliness of Care

(Included in FY2019 and Excluded in FY2017, FY2020, FY2021)

Timeliness of Care OP-20 (2019) Door to Diagnostic Evaluation by a Qualified Medical Professional Timeliness of Care

(Included in FY2019 and Excluded in FY2017, FY2020, FY2021)

Timeliness of Care OP-21 (2019) Median Time to Pain Management for Long Bone Fracture Timeliness of Care

(Included in FY2019 and Excluded in FY2017, FY2020, FY2021)

Efficient Use of Medical Imaging OP-8 MRI lumbar spine for low back pain Efficient Use of Medical Imaging
Efficient Use of Medical Imaging OP-10 Abdomen CT - use of contrast material Efficient Use of Medical Imaging
Efficient Use of Medical Imaging OP-11 Thorax CT Use of Contrast Material Efficient Use of Medical Imaging

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

Efficient Use of Medical Imaging OP-13 Cardiac imaging for preoperative risk assessment for non-cardiac low-risk surgery Efficient Use of Medical Imaging
Efficient Use of Medical Imaging OP-14 Outpatients with brain CT scans who got a sinus CT scan at the same time Efficient Use of Medical Imaging

(Included in FY2017, FY2019, FY2020 and Excluded in FY2021)

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CMS Star Rating

CMS has implemented a 5-star rating system to evaluate the experiences medicare beneficiaries have with their healthcare service providers. The hospitals are rated on a scale of 1 to 5, with 5 being the highest. While there are no financial incentives linked to the program, the rating determines the reputation of hospitals, and patients are motivated to go with the hospitals that have the highest rating. There is a total of 5 measure groups with each one contributing a different percentage to the overall rating.

Measure Name Description FY 2017 FY 2019 FY 2020 FY 2021
Mortality
MORT-30-AMI AMI- 30-day Mortality Rate
MORT-30-CABG CABG-30-day Mortality Rate
MORT-30-COPD COPD-30-day Mortality Rate
MORT-30-HF HF-30-day Mortality Rate
MORT-30-PN Pneumonia -30-day Mortality Rate
MORT-30-STK Stroke 30-day Mortality Rate
PSI-4-SURG-COMP Death rate among surgical inpatients with serious treatable complications
Safety of Care
HAI-1 CLABSI in ICUs and Select Wards
HAI-2 CAUTI in ICUs and Select Wards
HAI-3 SSI: Colon
HAI-4 SSI: Hysterectomy
HAI-5 MRSA - Bloodstream Infections
HAI-6 C.diff. - Intestinal Infections
COMP-HIP-KNEE Risk-Standardized Complication Rate - Following elective primary THA and TKA
PSI-90-Safety Patient safety and adverse events composite
Readmission
READM-30-CABG CABG - Surgery 30-day Readmission Rate
READM-30-COPD COPD- 30-day Readmission Rate
READM-30-Hip-Knee 30-day readmission rate following elective primary THA and/or TKA
READM-30-HOSP-WIDE 30-day hospital-wide all- cause unplanned readmission (HWR)
EDAC-30-AMI AMI - Excess Days in Acute Care
EDAC-30-HF HF - Excess Days in Acute Care
EDAC-30-PN PN - Excess Days in Acute Care
OP-32 Facility 7-day risk standardized hospital visit rate after outpatient colonoscopy
READM-30-STK Stroke -30-Day Readmission Rate
Patient Experience
H-CLEAN-HSP Cleanliness of Hospital Environment
H-COMP-1 Communication with Nurses
H-COMP-2 Communication with Doctors
H-COMP-3 Responsiveness of Hospital Staff
H-COMP-5 Communication about Medicines
H-COMP-6 Discharge Information
H-HSP-RATING Overall Rating of Hospital
H-QUIET-HSP Quietness of Hospital Environment
H-RECMND Willingness to Recommend the Hospital
H-COMP-7 Care Transition
Timely and Effective Care
IMM-2 Influenza immunization
IMM-3 Influenza vaccination coverage among healthcare personnel
OP-22 Left without being seen
OP-23 Head CT scan results for acute ischemic stroke or hemorrhagic stroke who received head CT scan interpretation within 45 minutes of arrival
OP-29 Appropriate follow-up interval for normal colonoscopy in average risk patients
OP-30 Colonoscopy interval for patients with a history of adenomatous polyps - avoidance of inappropriate use
OP-33 External beam radiotherapy for bone metastases
PC-01 Elective delivery prior to 39 completed weeks of gestation
SEP-1 Early management bundle, severe sepsis/septic shock
VTE-6 Hospital acquired potentially preventable venous thromboembolism
OP-4 Aspirin at Arrival
ED-1b Average (median) time patients spent in the emergency department, before they were admitted to the hospital as an inpatient A lower number of minutes is better
ED-2b Median time from admit decision to time of departure from the emergency department for patients admitted to inpatient status
OP-2 Fibrinolytic therapy received within 30 minutes of emergency department arrival
OP-3b Median time to transfer to another facility for acute coronary intervention
OP-5 Median Time to ECG
OP-18b Median time from emergency department arrival to emergency department departure for discharged patients
OP-1 Median Time to Fibrinolysis
OP-20 Door to Diagnostic Evaluation by a Qualified Medical Professional
OP-21 Median Time to Pain Management for Long Bone Fracture
OP-8 MRI lumbar spine for low back pain
OP-10 Abdomen CT - use of contrast material
OP-11 Thorax CT Use of Contrast Material
OP-13 Cardiac imaging for preoperative risk assessment for non-cardiac low-risk surgery
OP-14 Outpatients with brain CT scans who got a sinus CT scan at the same time

Generally, the four outcome measure groups (Mortality, Safety of Care, Patient Experience, Timely and Effective Care) were weighted at 22% each, and the three process measure groups (Effectiveness of Care, Timeliness of care, Efficient Use of Medical Imaging) were weighted at 4% each in FY 2017, 2019, and 2020. In FY 2021, four outcome measure groups' weightage remain the same at 22% and three process measure groups (Effectiveness of Care, Timeliness of Care, and Efficient Use of Medical Imaging) are consolidated into one process measure group called Timely and Effective Care with a weightage of 12%.

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Value Based Purchasing

The hospital Value-Based Purchasing (VBP) program was implemented to improve the clinical outcomes, efficiency, safety of patients during the inpatient stays. CMS has developed different metrics to evaluate the performance of the hospitals and provide financial incentives to hospitals based on the measures. CMS has grouped these measures under four domains namely: Clinical outcomes, Efficiency and Cost reduction, Safety, and Person and Community engagement. Each domain weighs 25% of the Total Performance Score.

Measure Payment Year VBP Program
FY 2020 FY 2021 FY 2022 FY 2023 FY 2024 FY 2025 FY 2026
Clinical Outcomes
Baseline Year (AMI mortality, HF mortality, COPD mortality, CABG mortality)

Note: COPD mortality is applicable from 2021, CABG mortality is applicable from 2022

07/01/2010 - 06/30/2013 07/01/2011 - 06/30/2014 07/01/2012 - 06/30/2015 07/01/2013 - 06/30/2016 07/01/2014 - 06/30/2017 07/01/2015 - 06/30/2018 07/01/2016 - 06/30/2019
Performance Year (AMI mortality, HF mortality, COPD mortality, CABG mortality)

Note: COPD mortality is applicable from 2021, CABG mortality is applicable from 2022

07/01/2015 - 06/30/2018 07/01/2016 - 06/30/2019 07/01/2017 - 06/30/2020 07/01/2018 - 06/30/2021 07/01/2019 - 06/30/2022 07/01/2020 - 06/30/2023 07/01/2021 - 06/30/2024
PN mortality Baseline Year 07/01/2010 - 06/30/2013 07/01/2012 - 06/30/2015 07/01/2012 - 06/30/2015 07/01/2013 - 06/30/2016 07/01/2014 - 06/30/2017 07/01/2015 - 06/30/2018 07/01/2016 - 06/30/2019
PN mortality Performance Year 07/01/2015 - 06/30/2018 09/01/2017 - 06/30/2019 09/01/2017 - 06/30/2020 07/01/2018 - 06/30/2021 07/01/2019 - 06/30/2022 07/01/2020 - 06/30/2023 07/01/2021 - 06/30/2024
THA/TKA complications Baseline Year 07/01/2010 - 06/30/2013 04/01/2011 - 03/31/2014 04/01/2012 - 03/31/2015 04/01/2013 - 03/31/2016 04/01/2014 - 03/31/2017 04/01/2015 - 03/31/2018 04/01/2016 - 03/31/2019
THA/TKA complications Performance Year 07/01/2015 - 06/30/2018 04/01/2016 - 03/31/2019 04/01/2017 - 03/31/2020 04/01/2018 - 03/31/2021 04/01/2019 - 03/31/2022 04/01/2020 - 03/31/2023 04/01/2021 - 03/31/2024
AMI mortality
HF mortality
PN mortality
THA/TKA complications
COPD mortality
CABG mortality
HCAHPS/Patient Experience
Baseline Year 01/01/2016 - 12/31/2016 01/01/2017 - 12/31/2017 01/01/2018 - 12/31/2018 01/01/2019 - 12/31/2019 01/01/2020 - 12/31/2020 01/01/2021 - 12/31/2021 01/01/2022 - 12/31/2022
Performance Year 01/01/2018 - 12/31/2018 01/01/2019 - 12/31/2019 01/01/2020 - 12/31/2020 01/01/2021 - 12/31/2021 01/01/2022 - 12/31/2022 01/01/2023 - 12/31/2023 01/01/2024 - 12/31/2024
H-CLEAN-HSP
H-COMP-1
H-COMP-2
H-COMP-3
H-COMP-5
H-COMP-6
H-HSP-RATING
H-QUIET-HSP
H-RECMND
H-COMP-7
Efficiency and Cost Reduction
Baseline Year 01/01/2016 - 12/31/2016 01/01/2017 - 12/31/2017 01/01/2018 - 12/31/2018 01/01/2019 - 12/31/2019 01/01/2020 - 12/31/2020 01/01/2021 - 12/31/2021 01/01/2022 - 12/31/2022
Performance Year 01/01/2018 - 12/31/2018 01/01/2019 - 12/31/2019 01/01/2020 - 12/31/2020 01/01/2021 - 12/31/2021 01/01/2022 - 12/31/2022 01/01/2023 - 12/31/2023 01/01/2024 - 12/31/2024
Medicare Spending Per Beneficiary (MSPB) - Hospital
Safety
CMS PSI-90 Patient Safetyand Adverse Events Composite Baseline Year 10/01/2015 - 06/30/2017 07/01/2016 - 06/30/2018 07/01/2017 - 06/30/2019 07/01/2018 - 06/30/2020
CMS PSI-90 Patient Safetyand Adverse Events Composite Performance Year 07/01/2019 - 06/30/2021 07/01/2020 - 06/30/2022 07/01/2021 - 06/30/2023 07/01/2022 - 06/30/2024
Baseline Year (CLABSI, CAUTI, SSI, MRSA, C diff, PC-01 Elective delivery) 01/01/2016 - 12/31/2016 01/01/2017 - 12/31/2017 01/01/2018 - 12/31/2018 01/01/2019 - 12/31/2019 01/01/2020 - 12/31/2020 01/01/2021 - 12/31/2021 01/01/2022 - 12/31/2022
Performance Year (CLABSI, CAUTI, SSI, MRSA, C diff, PC-01 Elective delivery) 01/01/2018 - 12/31/2018 01/01/2019 - 12/31/2019 01/01/2020 - 12/31/2020 01/01/2021 - 12/31/2021 01/01/2022 - 12/31/2022 01/01/2023 - 12/31/2023 01/01/2024 - 12/31/2024
CMS PSI-90 Patient Safetyand Adverse Events Composite
CLABSI
CAUTI
SSI
MRSA
C diff
PC-01 Elective delivery

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Hospitals Readmissions Reduction Program

HRRP is intended to improve the communication and coordination between caregivers and patients in developing discharge plans to avoid possible readmissions. The program achieves the goal by linking payments to value outcomes. CMS considers 6 conditions as part of the program and calculates the 30-day readmission measure. The payments are determined based on the performance of the hospital during a 3-year period.

  • Acute myocardial infarction (AMI)

  • Chronic obstructive pulmonary disease (COPD)

  • Heart failure (HF)

  • Pneumonia

  • Coronary artery bypass graft (CABG) surgery

  • Elective primary total hip arthroplasty and/or total knee arthroplasty (THA/TKA)

*Abbreviated performance periods due to the data exclusions stipulated in an Interim Final Rule (CMS-3401-IFC) which specifies that CMS will exclude claims data and HAI data that hospitals have submitted for Q1 2020 and Q2 2020 from program calculations for the HRRP.

Measure Payment Year in HRRP
FY 2020 FY 2021 FY 2022 FY 2023
Performance Periods 07/01/2015 - 06/30/2018 07/01/2016 - 06/30/2019 07/01/2017 - 12/31/2019* 07/01/2018 - 12/31/2019
&
07/01/2020 - 06/30/2021*
AMI readmissions
HF readmissions
PN readmissions
THA/TKA readmissions
COPD readmissions
CABG readmissions

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Hospital-Acquired Condition Reduction Program

Through this program, CMS aims to reduce hospital-acquired infections that occur as a result of negligence and improve the quality of care during inpatient stays. CMS links financial payments to the HAC measures to encourage hospitals to improve their score. CMS uses the total HAC score to determine the lowest-scoring hospitals and reduces payment while paying the medicare claims. The total HAC score is calculated using 6 measures:

  • Patient Safety Indicator (PSI) 90

  • Central Line-Associated Bloodstream Infection (CLABSI)

  • Catheter-Associated Urinary Tract Infection (CAUTI)

  • Surgical Site Infection (SSI) – colon and hysterectomy

  • Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia

  • Clostridium difficile Infection (CDI)

*Abbreviated performance periods due to the data exclusions stipulated in an Interim Final Rule (CMS-3401-IFC) which specifies that CMS will exclude claims data and HAI data that hospitals have submitted for Q1 2020 and Q2 2020 from program calculations for the HAC Reduction Program.

Measure Payment Year HAC Program
FY 2020 FY 2021 FY 2022 FY 2023
CMS PSI-90 Patient safety for selected indicators (composite) Performance Periods 07/01/2016 - 06/30/2018 07/01/2017 - 06/30/2019 07/01/2018 - 12/31/2019* 07/01/2019 - 12/31/2019
&
07/01/2020 - 06/30/2021*
Performance Periods (CLABSI, CAUTI, Colon and Abdominal Hysterectomy SSI, MRSA Bacteremia, CDI Clostridium difficile Infection) 01/01/2017 - 12/31/2018 01/01/2018 - 12/31/2019 01/01/2019 - 12/31/2019
&
07/01/2020 - 12/31/2020*
07/01/2020 - 12/31/2021*
CMS PSI-90 Patient safety for selected indicators (composite)
CLABSI
CAUTI
Colon and Abdominal Hysterectomy SSI
MRSA Bacteremia
CDI Clostridium difficile Infection

CMS finalized the adoption of the Equal Measure Weights approach in the FY 2019. The Equal Measure Weights approach applies an equal weight to each measure for which a hospital has a measure score. In the following diagram standard weight for each measure is 16.67% when hospital has all 6 measures score. In Re-proportioned Weight Scenario A, hospital has 5 measures score and weight for each measure is 20% as per Equal Measure Weights approach. In Re-proportioned Weight Scenario B, hospital has 4 measures score and weight for each measure is 25% as per Equal Measure Weights approach. In Re-proportioned Weight Scenario C, hospital has 3 measures score and weight for each measure is 33.33% as per Equal Measure Weights approach. In Re-proportioned Weight Scenario D, hospital has 2 measures score and weight for each measure is 50% as per Equal Measure Weights approach.

CMS takes an extended amount of time in calculating the measures and releasing the scores to healthcare service providers. Hospitals can not devise any actionable plans to address the low scoring areas due to the time delay. Dexur replicates the same algorithms and provides data at DRG levels at a much faster rate to help hospitals develop specific plans to improve their score.

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Impact of different measures on CMS programs

Mortality Rates

The mortality rate is an important metric that has a significant weightage in different CMS programs. It weighs 22% in the CMS Star Rating program and 25% in the VBP program under the Clinical Outcomes domain. Dexur provides the mortality rates for different time periods at DRG levels to help hospitals understand their performance. Hospitals can give special attention to conditions that have a high mortality rate and come up with specific treatment plans to improve their score. Only certain conditions are taken into account in calculating the mortality score for VBP and Star Rating program.

  • AMI 30 Day Mortality Rate

  • CABG 30 Day Mortality Rate

  • COPD 30 Day Mortality Rate

  • Heart Failure 30 Day Mortality Rate

  • Pneumonia 30 Day Mortality Rate

  • Stroke 30-day Mortality Rate

  • Death rate among surgical inpatients with serious treatable complications

Safety/Hospital-Acquired Conditions

Safety is another important metric that impacts multiple CMS programs. The safety measure forms an integral part of VBP program contributing 25% to it. The metric also weighs 22% in the star rating program. The metric is used to assess the safety aspect of hospitals and prevent the occurrence of infections during the inpatient stay.

MSPB

MSPB is the sole metric used to calculate the Efficiency and Cost reduction domain in the VBP program. It measures the cost to Medicare for services performed by healthcare providers. The costs incurred from 3-day prior admission period to 30-day post-discharge is used to calculate the MSPB costs. In order to calculate the MSPB for each hospital, Dexur determined the time frame of the spending per beneficiary episode during which Medicare payments would be aggregated and the type of Medicare payments to be aggregated over this time frame. See Dexur’s MSPB features here.

Readmission Rates

The readmission rate weighs 22% in the star rating program and also has a significant impact on the VBP program under the MSPB domain. The star rating program only considers the readmission rate of certain conditions, the same ones used to calculate the mortality rate. The readmission rates are calculated post 30 days from the discharge period.

HCAHPS scores

CMS uses the HCAHPS score to calculate the Personal and Community Engagement domain in the VBP program and Patient Experience in the star rating program. CMS developed a standardized survey of patient’s healthcare experience in collaboration with AHRQ (Agency for Healthcare Research and Quality). The survey is comprised of 27 questions that measure a patient’s experience with:

  • Communication with healthcare service providers

  • Information about medicines

  • 3-item care transition

  • Responsiveness

  • Hospital hygiene

  • Discharge information

  • Overall rating of the hospital

The survey is not limited to Medicare beneficiaries and any patient who has spent at least one night in a hospital facility can participate in the survey. The patients would be requested to fill the survey from 48 hours to 6 weeks after the discharge.

Timely and Effective Care Measures

The measures of timely and effective care, also known as process of care measures, part of the CMS Star-Rating, show how often or how quickly hospitals provide care that research shows gets the best results for patients with cataract surgery, a colonoscopy, a heart attack, emergency department care, preventative care, a stroke, a blood clot, or childbirth. Hospitals voluntarily submit data from their medical records about the treatments their patients receive for these conditions, including patients with Medicare and those who do not have Medicare.

Efficient Use of Medical Imaging

The measures on the use of medical imaging show how often a hospital provides specific imaging tests for Medicare beneficiaries under circumstances where the imaging may not be medically appropriate. Lower percentages suggest more efficient use of medical imaging. The measure is only aplicaple for Medicare patients who were treated in an outpatient setting. Measures included in calculator of CMS Star Rating are as following:

  • MRI lumbar spine for low back pain

  • Abdomen CT - use of contrast material

  • Thorax CT Use of Contrast Material

  • Cardiac imaging for preoperative risk assessment for non-cardiac low-risk surgery

  • Outpatients with brain CT scans who got a sinus CT scan at the same time