Total Estimated Medicare Spending Per Beneficiary - Post-Acute Care

Identifying Attributes

Care Settings
Home Care
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Home Health Quality Reporting Program
Type of Quality Indicator
Outcome
IOM Quality Dimension
Efficiency
Domain
Resource Use

Defining Attributes

Definition

The assessment of the Medicare spending of a home health agency's Medicare Spending Per Beneficiary - Post-Acute Care (MSPB-PAC) home health episodes, relative to the Medicare spending of the national median home health agency s MSPB-PAC home health episodes across the same performance period. Note: An MSPB-PAC home health measure score of less than 1 indicates that a given home health agency s resource use is less than that of the national median home health agency during the same performance period.

Numerator

The numerator is called the MSPB-PAC Amount. This is the average observed over expected (as predicted through risk adjustment) Medicare spending for a home health agency s MSPB-PAC home health episodes, multiplied by the national average MSPB-PAC home health spending.

Denominator

The denominator for MSPB-PAC measure is the episode-weighted national median of the MSPB-PAC Amounts across all home health agencies.

Exclusions

Episodes triggered by a claim outside the 50 states, D.C., Puerto Rico, and U.S. territories Episodes where the claim(s) constituting the attributed home health agency s treatment have a standard allowed amount of zero or where the standard allowed amount cannot be calculated. Episodes where the patient is not continuously enrolled in Medicare FFS for the 90 days before the episode trigger (lookback period) through to the end of the episode window, or is enrolled in Part C for any part of this period. This includes cases where the beneficiary dies during this period. Episodes in which a patient has a primary payer other than Medicare during the 90-day lookback period or episode window Episodes where the claim(s) constitution the attributed home health agency's treatment include a non-PPS related condition code Episodes triggered by a RAP claim Episodes with outlier residuals below the 1st percentile or above the 99th percentile of the residual distribution.

Use of Risk Adjustment
Yes
Risk Adjustments

The MSPB-PAC models use a linear regression framework and a 90-day HCC lookback period. Adjusted for health status as per the CMS Hierarchical Condition Categories framework, age at the start of the episode, Original entitlement to Medicare through disability, ESRD, Long-term care institutionalization at start of episode, clinical case mix categories reflecting recent prior care, Hospice utilisation during the episode, Prior acute ICU utilisation day categories, Prior acute length of stay categories.

Stratifications

None

Data Attributes

Type of Data Collection
Administrative data
Data Collection Methods

Medicare fee-for-service (FFS) claims data.. Uses a 90-day lookback period

Frequency of Data Collection
Quarterly
Frequency of Data Collection in Days
91
Reporting Methods

Home Health Quality Reporting (CMS and providers) CMS Care Compare - Home health services and CMS Provider Compare (CMS, providers and publicly reported online) Included in the Quality of Patient Care star rating algorithm (CMS, providers and publicly reported online).

Reporting Frequency
Quarterly
Reporting Frequency in Days
91
Indicator Has Recommended Targets
No

Source and Reference Attributes

Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
12 March 2025