[ { "category": "cost", "title": "Medicare Spending Per Beneficiary (MSPB)", "description": "The risk-adjusted cost to Medicare for all Parts A and B services performed for an inpatient beneficiary as a result of a clinician's care during the period 3 days prior to the patient's hospital stay through 30 days after discharge.", "measureId": "MSPB_1", "metricType": "costScore", "firstPerformanceYear": 2017, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-mspb-clinician.pdf" } }, { "category": "cost", "title": "Total Per Capita Costs (TPCC)", "description": "The overall, payment-standardized, annualized, risk-adjusted, and specialty-adjusted cost of care provided to beneficiaries attributed to their primary care clinicians.", "measureId": "TPCC_1", "metricType": "costScore", "firstPerformanceYear": 2017, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-tpcc.pdf" } }, { "category": "cost", "title": "Routine Cataract Removal with Intraocular Lens (IOL) Implantation", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries who undergo a procedure for routine cataract removal with IOL implantation during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from 60 days prior to the cataract removal procedure that triggers the episode through 90 days after the trigger.", "measureId": "COST_IOL_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-cataract.pdf" } }, { "category": "cost", "title": "Intracranial Hemorrhage or Cerebral Infarction", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries hospitalized for cerebral infarction or intracranial hemorrhage during the performance period. Includes costs of services clinically related to the attributed clinician’s role in managing care from the inpatient hospitalization that triggers the episode through 90 days after the trigger.", "measureId": "COST_IHCI_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-ich-cva.pdf" } }, { "category": "cost", "title": "Knee Arthroplasty", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries who undergo an elective knee arthroplasty during the performance period. Includes costs of services clinically related to the attributed clinician’s role in managing care from 30 days prior to the knee arthroplasty that triggers the episode through 90 days after the trigger.", "measureId": "COST_KA_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-knee-arthro.pdf" } }, { "category": "cost", "title": "Elective Outpatient Percutaneous Coronary Intervention (PCI)", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries who undergo elective outpatient PCI surgery to place a coronary stent for heart disease during the performance period. Includes costs of services clinically related to the attributed clinician’s role in managing care from the PCI surgery that triggers the episode through 30 days after the trigger.", "measureId": "COST_EOPCI_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-op-pci.pdf" } }, { "category": "cost", "title": "Simple Pneumonia with Hospitalization", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries hospitalized with simple pneumonia during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from the inpatient hospitalization that triggers the episode through 30 days after the trigger.", "measureId": "COST_SPH_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-pna-hosp.pdf" } }, { "category": "cost", "title": "Revascularization for Lower Extremity Chronic Critical Limb Ischemia", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries who undergo elective revascularization surgery for lower extremity chronic critical limb ischemia during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from 30 days prior to the revascularization procedure that triggers the episode through 90 days after the trigger.", "measureId": "COST_CCLI_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-rleccli.pdf" } }, { "category": "cost", "title": "Screening/Surveillance Colonoscopy", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries who receive a screening/surveillance colonoscopy. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from the screening/surveillance colonoscopy procedure that triggers the episode through 14 days after the trigger.", "measureId": "COST_SSC_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-ss-clnscpy.pdf" } }, { "category": "cost", "title": "ST-Elevation Myocardial Infarction (STEMI) with Percutaneous Coronary Intervention (PCI)", "description": "A clinician's risk-adjusted cost to Medicare for beneficiaries who present with STEMI, indicating complete blockage of a coronary artery, who emergently receive PCI as treatment during the performance period. Includes costs of services that are clinically related to the attributed clinician’s role in managing care from the inpatient hospitalization that triggers the episode through 30 days after the trigger.", "measureId": "COST_STEMI_1", "metricType": "costScore", "firstPerformanceYear": 2019, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": "simpleAverage", "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications//2020-12-14-mif-ebcm-stemi-pci.pdf" } }, { "category": "cost", "title": "Acute Kidney Injury Requiring New Inpatient Dialysis", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Acute Kidney Injury Requiring New Inpatient Dialysis episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive their first inpatient dialysis service for acute kidney injury during the performance period. The cost measure score is the clinician’s 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 each episode from the clinical event that opens, or “triggers,” the episode through 30 days after the trigger.", "measureId": "COST_AKID_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-aki-new-hd.pdf" } }, { "category": "cost", "title": "Elective Primary Hip Arthroplasty", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Elective Primary Hip Arthroplasty episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive an elective primary hip arthroplasty during the performance period. The cost measure score is the clinician’s 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 each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.", "measureId": "COST_PHA_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-el-ha.pdf" } }, { "category": "cost", "title": "Femoral or Inguinal Hernia Repair", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Femoral or Inguinal Hernia Repair episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo surgical procedure to repair a femoral or inguinal hernia during the performance period. The cost measure score is the clinician’s 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 each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.", "measureId": "COST_FIHR_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-fihr.pdf" } }, { "category": "cost", "title": "Hemodialysis Access Creation", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Hemodialysis Access Creation episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo a procedure for the creation of graft or fistula access for long-term hemodialysis during the performance period. The cost measure score is the clinician’s 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 each episode from 60 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.", "measureId": "COST_HAC_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-hd-access.pdf" } }, { "category": "cost", "title": "Inpatient Chronic Obstructive Pulmonary Disease (COPD) Exacerbation", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Inpatient COPD Exacerbation episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive inpatient treatment for an acute exacerbation of COPD during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This acute inpatient medical condition measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from the clinical event that opens, or “triggers,” the episode through 60 days after the trigger.", "measureId": "COST_COPDE_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-ip-copd.pdf" } }, { "category": "cost", "title": "Lower Gastrointestinal Hemorrhage (groups only)", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Lower Gastrointestinal Hemorrhage episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive inpatient non-surgical treatment for acute bleeding in the lower gastrointestinal tract during the performance period. The cost measure score is the clinician’s risk-adjusted cost for the episode group averaged across all episodes attributed to the clinician. This acute inpatient medical condition measure includes costs of services that are clinically related to the attributed clinician’s role in managing care during each episode from the clinical event that opens, or “triggers,” the episode through 35 days after the trigger.", "measureId": "COST_LGH_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-lgi-bleed.pdf" } }, { "category": "cost", "title": "Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Lumbar Spine Fusion for Degenerative Disease, 1-3 Levels episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo surgery for lumbar spine fusion during the performance period. The cost measure score is the clinician’s 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 each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.", "measureId": "COST_LSFDD_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-l-fusion.pdf" } }, { "category": "cost", "title": "Lumpectomy Partial Mastectomy, Simple Mastectomy", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Lumpectomy, Partial Mastectomy, Simple Mastectomy episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo partial or total mastectomy for breast cancer during the performance period. The cost measure score is the clinician’s 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 each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.", "measureId": "COST_LPMSM_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-lump-mast.pdf" } }, { "category": "cost", "title": "Non-Emergent Coronary Artery Bypass Graft (CABG)", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Non-Emergent CABG episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who undergo a CABG procedure during the performance period. The cost measure score is the clinician’s 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 each episode from 30 days prior to the clinical event that opens, or “triggers,” the episode through 90 days after the trigger.", "measureId": "COST_NECABG_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-ne-cabg.pdf" } }, { "category": "cost", "title": "Renal or Ureteral Stone Surgical Treatment", "description": "Episode-based cost measures represent the cost to Medicare for the items and services provided to a patient during an episode of care (“episode”). In all supplemental documentation, “cost” generally means the standardized1 Medicare allowed amount,2 and claims data from Medicare Parts A and B are used to construct the episode-based cost measures. The Renal or Ureteral Stone Surgical Treatment episode-based cost measure evaluates a clinician’s risk-adjusted cost to Medicare for beneficiaries who receive surgical treatment for renal or ureteral stones during the performance period. The cost measure score is the clinician’s 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 each episode from 90 days prior to the clinical event that opens, or “triggers,” the episode through 30 days after the trigger.", "measureId": "COST_RUSST_1", "metricType": "costScore", "firstPerformanceYear": 2020, "lastPerformanceYear": null, "isInverse": true, "overallAlgorithm": null, "submissionMethods": [ "administrativeClaims" ], "measureSpecification": { "default": "https://qpp.cms.gov/docs/cost_specifications/2020-12-14-mif-ebcm-rn-stone.pdf" } } ]