Inpatient rehabilitation facility (IRF) providers' resource use relative to the resource use of the national median IRF provider.

The numerator for a post-acute care (PAC) provider's Medicare spending per beneficiary-PAC measure is the MSPB-PAC Amount. The MSPB-PAC Amount is the average risk-adjusted episode spending across all episodes for the attributed provider, multiplied by the national average episode spending level for all post-acute care (PAC) providers in the same setting. The MSPB-PAC Amount for each post-acute care (PAC) provider depends on two factors: (1) the average of the ratio of the standardised episode spending level to the expected episode spending for each post-acute care (PAC) provider; and (2) the average standardised episode spending across all post-acute care (PAC) providers of the same type. To calculate the MSPB-PAC Amount for each post-acute care (PAC) provider, one calculates the average of the ratio of the standardised episode spending over the expected episode spending, and then multiplies this quantity by the average episode spending level across all post-acute care (PAC) providers of the same type.

The denominator for a PAC provider's MSPB-PAC measure is the episode-weighted national median of the MSPB-PAC Amounts across all PAC providers in the same setting.

Exclusions from All MSPB-PAC Measures (1) Any episode that is triggered by a PAC claim outside the 50 states, D.C., Puerto Rico, and U.S. Territories. This exclusion ensures that complete claims data are available for each provider. (2) Any episode where the claim(s) constituting the attributed PAC provider's treatment have a standard allowed amount of zero or where the standard allowed amount cannot be calculated. Episodes where the claim(s) constituting the attributed PAC provider's treatment are zero or have unknown allowed payment do not reflect the cost to Medicare. Including these episodes in the calculation of MSPB-PAC measures could potentially misrepresent a providers' resource use.1(3) Any episode in which a patient is not enrolled in Medicare fee-for-service (FFS) for the entirety of a 90-day lookback period (i.e., a 90-day period prior to the episode trigger) plus episode window (including where a beneficiary dies), or is enrolled in Part C for any part of the lookback period plus episode window. Episodes meeting this criteria do not have complete claims information that is needed for risk adjustment and the measure calculation, as there may be other claims (e.g., for services provided under Medicare Advantage (Part C)) that we do not observe in the Medicare Part A and B claims data. Including these episodes in the MSPB-PAC measures could potentially misrepresent a provider's resource use. This exclusion also allows us to faithfully construct Hierarchical Condition Categories (HCCs) for each episode by scanning the lookback period prior to its start without missing claims. (4) Any episode in which a patient has a primary payer other than Medicare for any part of the 90-day lookback period plus episode window. Where a patient has a primary payer other than Medicare, complete claims data may not be observable. These episodes are removed to ensure that the measures are accurately calculated using complete data. (5) Any episode where the claim(s) constituting the attributed PAC provider's treatment include at least one related condition code indicating that it is not a prospective payment system bill. Claims that are not a prospective payment system bill may not report sufficient information to allow for payment standardisation. For example, this excludes Critical Access Hospital (CAH) swing beds from the MSPB-PAC SNF measure.21Claims that may not have a standard allowed amount include claims where the actual allowed amount is zero, claims that are not covered by Medicare, or claims for an inpatient (including LTCH and IRF) stay where the beneficiary has not yet been discharged. Furthermore, after a given service year of Medicare claims data has attained one year of run-out for claims processing, claims in that service year are no longer standardised. 2CMS, "Basics of Payment Standardisation". (2015) 13 www.qualitynet.org/dcs/BlobServer?blobkey=id&blobwhere=1228890462165&blobheader=multipart%2Foctet-stream&blobheadername1=ContentDisposition&blobheadervalue1=attachment%3Bfilename%3D42%2F42%2FCMSBasicsPaymntStdJune2015.pdf&blobcol=urldata&blobtable=MungoBlobs.

The MSPB-PAC models use a linear regression framework and a 90-day HCC lookback period. Risk adjustment is performed separately for the MSPB-PAC episode types listed below: • IRF • LTCH Site Neutral • LTCH Standard • SNF This ensures that comparisons are fair, meaningful, and reflective of payment policy differences within particular PAC settings. The following beneficiary health status indicators are included as covariates in each MSPB-PAC risk adjustment model and to the greatest extent possible are consistent across PAC settings (see Appendix C for a comprehensive list of independent variables used in the SNF, LTCH, and IRF risk adjustment models): • 70 HCCs • 11 HCC interactions • 11 brackets for age at the start of the episode • Original entitlement to Medicare through disability • ESRD • Long-term care institutionalization at start of episode1 • 6 clinical case mix categories reflecting recent prior care (described further below) • Hospice utilisation during the episode • Prior acute ICU utilisation day categories • Prior acute length of stay categories 1 Identifies beneficiaries who have been institutionalized for at least 90 days in a given year. The indicator is based on 90-day assessments from the Minimum Data Set (MDS) and is calculated based on CMS' definition of institutionalized individuals. 2 There are 7 case mix categories as described above, but one category is removed to prevent collinearity.

This measure is not stratified.

Medicare FFS claims and Medicare eligibility files. Claims-based measures can be calculated using data that have already been submitted to the Medicare program for payment purposes, no additional information collection is required from IRFs.

Medicare Program Reporting.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) Measures Information. Accessed August 3, 2023. Available from: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual. Accessed August 3, 2023. Available from: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf.

Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services (CMS), United States. Measure Specifications: Medicare Spending Per Beneficiary – Post-Acute Care Skilled Nursing Facility, Inpatient Rehabilitation Facility, and Long-Term Care Hospital Resource Use Measures. Accessed August 3, 2023. Available from: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/20160720mspbpacltchirfsnfmeasure_specs.pdf.

Inpatient Rehabilitation Facility - Quality Reporting Program: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-

Technical specifications: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf

Numerator/denominator: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/20160720mspbpacltchirfsnfmeasure_specs.pdf