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Meaningful Measure Area Definitions Purpose: To aid in continued understanding of the framework and assist as stakeholders understand and assign Meaningful Measure areas to quality measures, CMS developed definitions of the Meaningful Measure areas. For questions or comments, contact the CMS Meaningful Measures Team by e-mailing: MeaningfulMeasuresQA@cms.. Promote Effective Communication & Coordination of CareMeaningful Measure AreaDefinitionRelevancyMeasure ExamplesMedication Management This area covers measures focused on activities to optimize medication therapy, including reducing medication errors and maintaining and improving adherence to recommended medication regimens. An example of a medication management strategy is engaging with patients and caregivers to ensure that a complete and accurate medication list is maintained. [Note: Measures of care related to substance use disorders are not included here since they are covered in separate measure area.]Annual healthcare costs in the U.S. from Adverse Drug Events (ADEs) are estimated at $3.5 billion, resulting in 7,000 deaths annually. Avoid medication errors, drug interactions, and negative side effects by reconciling and tailoring prescriptions to meet the patient’s care needs.Medication Reconciliation for Patients Receiving Care at Dialysis Facilities: Used in the ESRD QIP; NQF#2988.Use of High-Risk Medications in the Elderly: Used in the MIPS Program; NQF#0022.Medication Adherence for Diabetes Medications: Used in the Medicare Part D Star Rating; based on NQF#0541.Asthma Medication Ratio: Used in the Medicaid and CHIP Child and Adult Core Sets; NQF #1800.Drug Regimen Review Conducted with Follow-Up for Identified Issues- Post Acute Care (PAC): Used in the LTCH, IRF, SNF, and HH QRPs.Admissions and Readmissions to HospitalsHealthcare quality can be improved by activities that decrease unnecessary and costly hospital admissions and readmissions, by achieving better care coordination in the healthcare system. This measurement area focuses on avoidance of unnecessary admission and readmission.Nearly 1 in 5 Medicare fee-for-service hospital discharges have previously resulted in a readmission within 30 days, accounting for more than $17 billion in avoidable Medicare expenditures. Prevent unplanned admissions and readmissions to the hospital; unplanned admissions and readmissions have negative impacts on patients, caregivers, and clinical resources, and can be prevented with effective care coordination and communication.Standardized Hospitalization Ratio for Admissions: Used in the ESRD QIP; NQF#1463.Hospital 30-Day, All-Cause, Risk-Standardized Readmission Rate (RSRR) Following Heart Failure (HF) Hospitalization: Used in the HRRP; NQF#0330.Hospital Visits after Hospital Outpatient Surgery: Finalized for the HOQR; NQF#2687.PQI 08: Heart Failure Admission Rate: Used in the Medicaid Adult Core Set; NQF #0277.Potentially Preventable 30-Days Post-Discharge Readmission Measure- Post Acute Care (PAC): Used in the LTCH, IRF, SNF, and HH QRPs.Transfer of Health Information and InteroperabilityHealth information should be accessed, exchanged, and used seamlessly. It is critical that health information be kept secure but readily accessible to patients, with the ability to transfer, receive, and use such information seamlessly and easily among additional authorized parties (providers, payers, beneficiaries, family members) at the time that it is needed. Measures included in this area address goals related to achieving a more connected and interoperable health information technology system.Fewer than 10% of physicians have fully functional Electronic medical record/electronic health record (EMR/EHR) systems. Promote interoperability to ensure current and useful information follows the patient and is available across every setting and at each healthcare interaction.The Ability for Providers with HIT to Receive Laboratory Data Electronically Directly into their Qualified/Certified EHR System as Discrete Searchable Data: Used in Hospital Compare and HOQR.Timely Transmission of Transition Record (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care): Used in Hospital Compare and IPFQR.Closing the Referral Loop: Receipt of Specialist Report: Used in MIPS.Support Electronic Referral Loops by Sending Health Information: Finalized for MIPS.Promote Effective Prevention & Treatment of Chronic DiseaseMeaningful Measure AreaDefinitionRelevancyMeasure ExamplesPreventive CarePreventive care services include routine healthcare activities such as screenings, check-ups, and counseling that are focused on helping individuals avoid or enable early detection of disease, reduce the impact of health conditions, and promote wellness. Measures in this area are targeted at promoting accessibility, quality, and outcomes of effective preventive services. Examples include: promotion of oral health in children, prevention of diabetes and heart disease, immunization status, cancer screenings.Many screening rates, like those for cancer, are below desired levels and reflect disparities across ethnicity/race. Prevent diseases by providing immunizations and evidence-based screenings, and promoting healthy life style behaviors and addressing maternal and child health.Breast Cancer Screening: Used in the MIPS Program and Shared Savings Program; NQF#2372.Influenza Vaccination Coverage Among Healthcare Personnel: Used in Hospital Compare, HOQR, and PCHQR; NQF#0431.Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Used in the MIPS Program; NQF#0421.Well-Child Visits in the First 15 Months of Life: Used in the Medicaid and CHIP Child Core Set, Medicaid and CHIP Scorecard, and QHP QRS; NQF#1392. Management of Chronic ConditionsConditions like heart disease, high blood pressure/hypertension, cancer, chronic pain, and diabetes are among the leading causes of morbidity and mortality in the United States. This area includes quality measures and efforts focused on effective ongoing health care to manage these types of chronic conditions. [Note: Measures of care related to medication management, behavioral and mental health, and substance use are not included here since they are covered in separate measure areas.]People with multiple chronic conditions account for 93% of total Medicare spending. Promote effective management of chronic conditions, particularly for those with multiple chronic conditions.Oncology: Medical and Radiation – Plan of Care for Moderate to Severe Pain (used in Hospital Compare: Used in the PCHQR and MIPS Program; NQF#0383.Diabetes: Hemoglobin A1c Poor Control (>9%): Used in the MIPS Program, Shared Savings Program, and the Medicaid Adult Core Set; NQF#0059.HIV Viral Load Suppression: Used in the MIPS Program and the Medicaid Adult Core Set; NQF#2082.Chronic Obstructive Pulmonary Disease: Spirometry Evaluation: Used in the MIPS Program; NQF#0091.Controlling High Blood Pressure: Used in the Medicaid Adult Core Set and the Medicaid and CHIP Scorecard; NQF #0018.Prevention, Treatment, and Management of Behavioral and Mental Health Mental health disorders can have a negative impact on a patient’s quality of life and physical health. Measures in this area focus on promoting opportunities to effectively screen and treat these conditions. [Note: Measures of care related to prevention and treatment of substance use disorders, including opioid use disorders, are not included here since they are covered in a separate measure area.]Annually, 1 in 5 or 43.8 million adults in the U.S. experience mental illness. Diagnosis, prevention and treatment of depression and effective management of mental disorders (e.g., schizophrenia, bipolar disorder), and dementia (e.g., Alzheimer’s disease) with emphasis on effective integration with primary care.Adult Major Depressive Disorder (MDD): Suicide Risk Assessment: Used in the MIPS Program; NQF#0104.Dementia: Cognitive Assessment: Used in the MIPS Program; NQF#2872.Follow-Up After Hospitalization for Mental Illness: Used in Hospital Compare, IPFQR, MIPS Program, Medicaid and CHIP Child and Adult Core Sets; and Medicaid and CHIP Scorecard; NQF#0576.Depression Remission at Six Months: Used in the MIPS Program; NQF#0711.Prevention and Treatment of Substance Abuse Disorders including Opioid Use DisordersSubstance use disorders related to use/inappropriate use of alcohol, tobacco, opioids, and other substances can be associated with significant clinical and functional impairment of the individuals who are affected. This area includes measures related to prevention and treatment of these disorders.Annually, three out of five drug overdose deaths involve an opioid, resulting in over $72 billion in medical costs. Ensure screening for and treatment of substance use disorders, including those co-occurring with mental health disorders.Initiation and Engagement of Alcohol and Other Drug Dependence Treatment: Used in the MIPS Program, the Medicaid Adult Core Set, and the Medicaid and CHIP Scorecard; NQF#0004.Use of Opioids at High Dosage in Persons Without Cancer: Used in the Medicaid Adult Core Set, and the Medicaid and CHIP Scorecard; NQF#2940.Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling: Used in the MIPS Program; NQF#2152.Tobacco Use and Help with Quitting Among Adolescents: Finalized for the MIPS Program; NQF#2803.Risk-Adjusted MortalityMeasuring mortality that occurs in proximity to healthcare service delivery can be used in efforts to promote high-quality care and accountability. Such measures may be risk-adjusted for certain patient characteristics (such as existing comorbid conditions) in an attempt to make more accurate comparisons of care quality.Heart disease, cancer, and chronic lower respiratory diseases are among the leading causes for death. Reduce mortality rate for patients in all healthcare settings.Risk-Adjusted Operative Mortality for Coronary Artery Bypass Graft (CABG): Used in the MIPS Program; NQF#0119.Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Pneumonia Hospitalization: Used in Hospital Compare, HIQR, and HVBP; NQF#0468.Operative Mortality Stratified by the Five STS-EACTS Mortality Categories: Finalized in the MIPS Program; NQF#0733.Make Care Safer by Reducing Harm Caused in the Delivery of CareMeaningful Measure AreaDefinitionRelevancy Measure ExamplesHealthcare-Associated InfectionsMeasures in this area focus on infections associated with the delivery of health care. Examples include MRSA, C-diff, central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections.”On any given day, about one in 25 hospital patients has at least one healthcare-associated infection. Prevent healthcare-associated infections that occur in all healthcare settings.Prevention of Central Venous Catheter (CVC)-Related Bloodstream Infections: Used in the MIPS Program; NQF#2726.National Healthcare Safety Network (NHSN) Facility-wide Inpatient Hospital-onset Clostridium difficile Infection (CDI) Outcome Measure: Used in the HACRP, Hospital Compare, HVBP, IRF QRP, LTCH QRP, and PCHQR; NQF#1717.Percent of Residents with a Urinary Tract Infection (Long Stay): Used in the Nursing Home Quality Initiative; NQF#0684.Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate: Used in the MIPS Program; NQF#0130.Pediatric Central Line-Associated Bloodstream Infections: Used in the Medicaid and CHIP Child Core Set; NQF #0139.Preventable Healthcare HarmThis area focuses on unintended adverse events caused or influenced by the delivery of health care that could be prevented by avoiding errors and following accepted standards of care. Examples include pressure ulcers, falls, acute kidney injury. [Note: Healthcare-Associated Infections (HAIs) and medication errors are not included here since they are covered in separate measure areas.]Each year, 2.8 million people are treated in emergency departments for fall injuries, with associated costs of $31 billion. Avoid non-infectious harms like falls and complications like bed sores; harm that occurs during care is a leading cause of significant morbidity and mortality, and occurs in both inpatient and outpatient settings.Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury: Used in the LTCH, IRF, SNF, and HH QRPs.Application of Percent of Residents Experiencing One or More Falls with Major Injury (Long Stay): Used in the LTCH, IRF, SNF, and HH QRPs; NQF #0674.Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure: Used in the MIPS Program; NQF#0114.Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant: Used in the ASCQR Program and Hospital Compare.Work with Communities to Promote Best Practices of Healthy LivingMeaningful Measure AreaDefinitionRelevancyMeasure ExamplesEquity of CareThis area focuses on measures used to advance care quality for minority and other underserved individuals, including measures of cultural competence and access to care. Such measures can be used as part of a broader strategy to increase understanding and awareness of disparities, develop relevant solutions, and promote faster implementation of effective actions.In 2015 compared to 1996 children and adults were more likely to visit a health provider. Ensure high quality and timely care with equal access for all patients and consumers, including those with social risk factors, for all health episodes in all settings of care.Access to Care: Used in the QHP munity EngagementCommunities can leverage a variety of resources to support the maintenance and improvement of health, function, and quality of life among the individuals and families of which they are comprised. Measures in this area target activities that promote engagement of communities to carry out these types of efforts.It is estimated that a $10 per person per year investment in community-based programs could save $16 billion in medical cost savings per year reflective of improved health. Increase the use and quality of home and community-based services (HCBS) to promote public health including a focus on health literacy.Discharge to Community- Post Acute Care (PAC): Used in the LTCH, IRF, SNF, and HH QRPs.Percentage of Participants Not in Nursing Homes: Under development for PACE.Make Care AffordableMeaningful Measure AreaDefinitionRelevancyMeasure ExamplesPatient-focused Episode of CareMeasures in this area emphasize care delivered through a longitudinal, episode-based approach that places the patient at the center of focus. These measures can help guide improvements in the effectiveness and efficiency of care.Approximately 30% of healthcare spending is for services without health benefits to patients. Improve care by optimizing health outcomes and resource use associated with treating acute clinical conditions or procedures.Hospital-level, Risk-Standardized Payment Associated with a 30-day Episode-of-Care for Heart Failure (HF): Used in Hospital Compare and HIQR; NQF #2436.Payment Standardized Medicare Spending Per Beneficiary: Used in Hospital Compare, HIQR, and HVBP; NQF#2158.Spinal Fusion Clinical Episode-Based Payment (SFusion Payment) Measure: Used in HIQR.Hospital-level, risk-standardized payment associated with a 90-day episode of care for elective primary total hip and/or total knee arthroplasty (THA/TKA): Used in Hospital Compare and HIQR.Risk Adjusted Total Cost of CareAssessing total cost of care can be used to help identify potential overuse and inefficiency of healthcare services, as well as potential opportunities for cost savings. Measures in this area may be risk-adjusted (for example, based on patient characteristics) in an attempt to make more accurate comparisons among entities providing care for different populations.In 2015, Medicaid spent $545.1 billion and Medicare spent $646.2 billion, with over 400 Medicare ACOs contributing more than $466 million in total program savings. Hold healthcare providers accountable for the total costs of care to mitigate out of pocket costs to the patient, lower costs to the Medicare program, ensure efficient use of high value services, improve the quality of care, and safeguard the future of services and programs, with a focus on price transparency and continual improvements in quality.Total Per Capita Costs: Used in the MIPS Program.Appropriate Use of HealthcareProvision of healthcare services or processes may not be appropriate when they are ineffective or do not lead to sufficient overall health benefit for a patient. This area focuses on measures designed to identify when appropriate care is (or is not) being delivered.Overuse of services is estimated to account for nearly $300 billion a year in expenditures. Ensure patients receive the care they need while avoiding unnecessary tests and procedures.Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use: Used in the MIPS Program; NQF#0654.Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients: Used in the MIPS Program; NQF#0389.Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac Low-Risk Surgery: Used in Hospital Compare and HOQR; NQF#0669.Strengthen Person & Family Engagement as Partners in their CareMeaningful Measure AreaDefinitionRelevancyMeasure ExamplesEnd of Life Care According to PreferencesThe National Institute on Aging defines end-of-life care as “the term used to describe the support and medical care given during the time surrounding death.” Measures in this area are intended to promote that this care should be delivered with consideration of the needs, values, and goals of the individual, caregiver, and their family.Fewer than 50% of even severely or terminally ill patients have an advance directive in their medical record. Ensure that care delivered at the end of life is in concert with patient/family preferences, which includes knowing those desires and providing aligned care and services.Hospice and Palliative Care Composite Process Measure – Comprehensive Assessment at Admission: Used in HQR; NQF#3235.Beliefs and Values - Percentage of hospice patients with documentation in the clinical record of a discussion of spiritual/religious concerns or documentation that the patient/caregiver did not want to discuss: Used in HQR; NQF#1647.Care is Personalized and Aligned with Patient’s GoalsEmphasizing person-centered care, measures in this area assess whether healthcare services and supports allow patients to achieve their desired outcomes. Examples include ensuring that individuals’ preferences are integrated into care delivery, incorporating patient-generated data in health records, and effectively involving individuals and families in managing their care effectively. [Note: Measures of personalized care near the end of life are not included here since they are covered in a separate measure area.]“…researchers have been using goal-attainment scaling for decades to measure the effect of treatment for conditions such as dementia and for comprehensive geriatric assessments”. Ensure the care delivered is in concert with individuals goals, aligned with the care plan co-created with their doctor and evidenced by people making informed decisions about their care.Hepatitis C: Discussion and Shared Decision Making Surrounding Treatment Options: Used in the MIPS Program.Patient-Centered Surgical Risk Assessment and Communication: Used in the MIPS Program.Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function: Used in the LTCH, IRF, SNF, and HH QRPs; NQF #2631.Functional OutcomesIt is critical to understand how health conditions affect an individual’s ability to independently carry out basic activities, including activities of daily living and instrumental activities of daily living, and participate in daily life, which correspond to a patient’s functional status. Measures in this area assess functional outcomes. Slightly more than 15% of adults report physical functioning difficulties. Improve or maintain patient’s quality of life by addressing physical functioning that affects their ability to undertake daily activities most important to them.Average Change in Functional Status Following Total Knee Replacement Surgery: Used in the MIPS Program; NQF#2653.Improvement in Pain Interfering with Activity: Used in HH QRP and HHVBP; NQF#0177.IRF Functional Outcome Measure: Discharge Mobility Score for Medical Rehabilitation Patients: Used in IRF Quality Reporting and the SNF Quality Reporting Program; NQF #2636.Improvement in Bathing; Used in HHVBP; NQF#0174.Patient’s Experience of CarePeople have a number of interactions with the healthcare system during the course of their care, such as experience with trying to get timely medical appointments, access to useful information, and effective communication with their healthcare providers. This measurement area is focused on evaluating these types of experience of care. [Note: Measures pertaining to equity of care are not included here since they are covered in a separate measure area.]Recent average positive reports of healthcare experiences showed variation across a range of factors, for example, from 52% for ‘Care transitions’ to 87% for ‘Discharge information’. Actively engage patients in reporting their experiences including satisfaction with care and staff, and community inclusion.Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Used in Hospital Compare, HIQR, HVBP, and PCHQR; NQF#0166.Getting Timely Care, Appointments and Information (component of CG-CAHPS): Used in the Shared Savings Program; NQF#0005.Overall Rating of Home Health Care (component of CAHPS Home Health Care Survey): Used in HH QRP and HHVBP; NQF#0517.Consumer Assessment of Healthcare Providers and Systems (CAHPS) Home and Community-Based Services Survey: Used in Medicaid; NQF#2967.Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey 5.0H Adult Version Medicaid: Used in the Medicaid Adult Core Set.List of AcronymsAmbulatory Surgical Center Quality Reporting Program (ASCQR) End-Stage Renal Disease Quality Incentive Program (ESRD QIP) Home Health Quality Reporting Program (HH QRP) Home Health Value Based Purchasing Program (HH VBP)Hospice Quality Reporting Program (HQRP) Hospital-Acquired Condition Reduction Program (HACRP) Hospital Inpatient Quality Reporting Program (IQR) Hospital Outpatient Quality Reporting Program (HOQR) Hospital Readmissions Reduction Program (HRRP) Hospital Value-Based Purchasing Program (HVBP) Inpatient Psychiatric Facility Quality Reporting Program (IPFQR) Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP) Long-Term Care Hospital Quality Reporting Program (LTCH QRP) Medicare and Medicaid Promoting Interoperability Program for Eligible Hospitals (EHs) and Critical Access Hospitals (CAHs) Medicare Shared Savings Program (Shared Savings Program) Merit-based Incentive Payment System (MIPS) National Quality Forum (NQF)Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting Program (PCHQR) Qualified Health Plan Quality Rating System (QHP QRS)Skilled Nursing Facility Quality Reporting Program (SNF QRP) Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP) ................
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