A clinician's risk-adjusted cost to Medicare for the items and services provided to patients who have an emergency department (ED) visit during the performance period. Each episode starts from the ED visit, through to 14 days after.

The sum of the ratio of observed to expected payment standardised cost to Medicare for all Emergency Medicine episodes attributed to a clinician. This sum is then multiplied by the national average observed episode cost to generate a dollar figure.

The total number of episodes from the Emergency Medicine episode group attributed to a clinician.

• Patients not enrolled in both Medicare Parts A and B for the entirety of the lookback period plus episode window. • Patients enrolled in a private Medicare health plan for any part of the lookback period plus episode window • The patient's date of birth is missing • The patient's death date occurred before or during the episode • An ED-to-ED transfer occurs • A hospital-to-hospital transfer occurs

• The MS-DRG of the index hospitalisation and indicators for any prior acute hospital admission. • Comorbidities captured by 86 Hierarchical Condition Category (HCC) codes • Interaction variables accounting for a range of comorbidities • Patient age category • Patient disability status • Patient end-stage renal disease (ESRD) status • Patient dual eligibility status • Recent use of institutional long-term care

By hospital and state.

Medicare Parts A and B claims data from the Common Working File (CWF) • Enrolment Data Base (EDB) • Long-Term Care Minimum Data Set (LTC MDS)

Hospital Care Compare Website. More detailed data is displayed at data.cms.gov

qpp.cms.gov/mips/cost

qpp.cms.gov/docs/cost_specifications/2023-12-05-mif-ebcm-emergency-v2.pdf