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How Medicare Measures Hospital Quality

Posted Jan 02 2013 12:00am

There are many ways that Medicare evaluates hospital quality. Medicare conducts patient surveys (i.e,. HCAHPS ). Medicare has hospitals report a variety of process of care measures through the Inpatient Quality Report (IQR) Program . Medicare uses data that Centers for Disease Control and Prevention (CDC) collects via the National Healthcare Safety Network ( NHSN ) tool to measure hospital-acquired infection (HAI) rates.

In addition to these initiatives, there are five main ways that Medicare evaluates hospital quality using claims data : (i) AHRQ patient safety and inpatient quality indicators; (ii) hospital acquired conditions, (iii) mortality, (iv) readmissions, and (v) spending per beneficiary. A list of the quality measures that fall under each category are listed below.

  • PSI 04 – Death among surgical inpatients with serious treatable complications
  • PSI 06 – Iatrogenic pneumothorax
  • PSI 11 – Postoperative respiratory failure
  • PSI 12 – Postoperative pulmonary embolism or deep vein thrombosis
  • PSI 14 – Postoperative wound dehiscence
  • PSI 15 – Accidental puncture or laceration
  • PSI 90 composite – Patient safety for selected indicators
  • IQI 11 – Abdominal aortic aneurysm (AAA) repair mortality
  • IQI 19 – Hip fracture mortality
  • IQI 91 composite – Mortality for selected conditions

For more information see QualityNet or the AHRQ website .

There is one more complication CMS added: Complication Rate Following Elective Primary THA and/or TKA .

For more information see QualityNET HACs .

  • 30-day mortality measures for Acute Myocardial Infarction
  • 30-day mortality measures for Heart Failure
  • 30-day mortality measures for Heart Failure Pneumonia
  • All-cause 30-day readmissions for acute myocardial infarction (AMI),
  • All-cause 30-day readmissions for heart failure (HF),
  • All-cause 30-day readmissions for pneumonia (PN)
  • Hospital-Wide All-Cause Unplanned Readmission Measure ( HWR )
  • 30-Day All-Cause Risk-Standardized Readmission Rate Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA )
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