Clinician-Group Risk-Standardised Acute Hospital Admission Rate for Patients With Multiple Chronic Conditions Under the Merit-Based Incentive Payment System

Identifying Attributes

Care Settings
Rural and Remote Care
Country
United States of America
Publishing Organisation
National Quality Forum
Type of Quality Indicator
Outcome
IOM Quality Dimension
Timeliness
Domain
Resources

Defining Attributes

Definition
Numerator

The outcome for this measure is the number of acute admissions per 100 person-years at risk for admission during the measurement period.

Denominator

Patients included in the measure (target patient population)

The target patient population for the outcome includes Medicare FFS patients aged 65 years and older with multiple chronic conditions (MCCs).

Provider types included for measurement

• Primary care providers (PCPs): CMS designates PCPs as physicians who practice internal medicine, family medicine, general medicine, or geriatric medicine, and non-physician providers, including nurse practitioners, certified clinical nurse specialists, and physician assistants.

• Relevant specialists: Specialists covered by the measure are limited to those who provide overall co-ordination of care for patients with MCCs and who manage the chronic diseases that put the MCCs patients in the measure at risk of admission. These specialists were chosen with input from our Technical Expert Panel (TEP) and include cardiologists, pulmonologists, nephrologists, neurologists, endocrinologists, and hematologists/oncologists. However, as indicated below and in Section S.9, the measure is not designed to assess the quality of care of cancer specialists who are actively managing cancer patients, and thus patients attributed to hematologists and oncologists are excluded from the measure.

Exclusions

We exclude patients from the cohort for these reasons:

  1. Patients without continuous enrolment in Medicare Part A or B during the measurement period.

  2. Patients enrolled in hospice at any time during the year prior to the measurement year or at start of the measurement year.

  3. Patients with no E&M visit to a MIPS eligible clinician.

  4. Patients assigned to clinicians who do not participate in the QPP on the MIPS track.

  5. Patients attributed to hematologists and oncologists.

  6. Patients not at risk for hospitalisation during the measurement year.

Use of Risk Adjustment
Yes
Risk Adjustments

Statistical risk model

Stratifications

Clinician: Group/Practice

Data Attributes

Type of Data Collection
Administrative data
Data Collection Methods

Claims data

Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
No

Source and Reference Attributes

Evidence Source

National Quality Forum 2022 Key Rural Measures: An Update List of Measures to Advance Rural Health Priorities, Draft 1, page 1-26

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
No
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
23 July 2025