The episode-based cost measures under development for potential use in the Quality Payment Program evaluate a clinician’s risk-adjusted cost for the episode group by averaging it across all episodes attributed to the clinician during the performance period.
The cost of each episode is the sum of the Medicare Parts A and B costs for clinically related items and services that have been assigned based on input received from a clinical subcommittee. These services include those performed by the attributed clinician as well as other health care providers during the episode window.
Medicare beneficiaries included in the measures are those enrolled continuously in Medicare Parts A and B, but not C, during the duration of the episode window. This cohort does not include Medicare beneficiaries for whom the following conditions apply:
- Medicare was not the primary payer
- The episode date does not end during the period of performance
- The patient died during the episode
Measure Name: Intracranial Hemorrhage or Cerebral Infarction
Description: This measure evaluates clinicians’ risk-adjusted cost for the Intracranial Hemorrhage or Cerebral Infarction episode group. This cost measure is meant to apply to clinicians who manage the inpatient care of Medicare beneficiaries hospitalized for an intracranial hemorrhage or cerebral infarction during the performance period. This cost measure excludes those patients whose initial hospitalization was due to a subarachnoid hemorrhage or a cerebral infarction which received thrombolytic therapy.
Input Received to Date: The Intracranial Hemorrhage or Cerebral Infarction measure has been developed with input from the Neuropsychiatric Disease Management Clinical Subcommittee convened between May – August 2017. This subcommittee comprises 24 individuals representing a total of 32 specialty societies. Subcommittee members provided detailed clinical input on each of the components of the cost measure described below.
Components: The components for the Intracranial Hemorrhage and Cerebral Infarction measure are as follows:
Defining the episode group: An Intracranial Hemorrhage and Cerebral Infarction episode is triggered by the inpatient E&M codes occurring during a Medicare beneficiary’s hospitalization for DRGs 064–066 and 070–072, (Intracranial Hemorrhage or Cerebral Infarction and Nonspecific Cerebrovascular Disorders), excluding certain diagnoses.
Attributing the episode group: An Intracranial Hemorrhage or Cerebral Infarction episode is attributed to the clinician(s) who bill(s) more than 30 percent of the inpatient E&M codes during the triggering hospitalization.
Assigning services to episode costs: Only services that have been determined to be clinically related to the episode (based on input from the clinical subcommittee) are included in episode costs. Services are assigned beginning with the trigger day through a post-trigger episode window up to 90 days after. The subcommittee initially selected a longer episode window but chose not to assign services in those additional days.
Risk adjusting: The Intracranial Hemorrhage or Cerebral Infarction cost measure accounts for case-mix severity using a risk adjustment model based off of the CMS-HCC model and is modified to include additional episode-group specific risk adjusters informed by the subcommittee’s input. Along with this, certain high-risk populations are excluded from the cost measure calculation to make the patient population more homogenous.
Additional information about the measure specifications, including the full list of assigned services and risk adjusters, will be publicly posted on the CMS website on October 16, 2017.