| Title |
Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data
|
Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data
|
Core Clinical Data Elements for the Hybrid Hospital-Wide Readmission Measure with Claims and Electronic Health Record Data - HWR
|
| CMS eCQM ID |
CMS529v3
|
CMS529v4
|
CMS529v5
|
| Short Name |
Hybrid HWR
|
Hybrid HWR
|
Hybrid HWR
|
| CBE ID* |
2879
|
2879e
|
2879
|
| Measure Steward |
Centers for Medicare & Medicaid Services (CMS)
|
Centers for Medicare & Medicaid Services (CMS)
|
Centers for Medicare & Medicaid Services (CMS)
|
| Description |
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWR ... outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals.
Show more >
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWR outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service patients admitted to acute care short stay hospitals.
Show less |
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWR ... outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service and Medicare Advantage patients admitted to acute care short stay hospitals.
Show more >
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWR outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from encounters for adult Medicare Fee-For-Service and Medicare Advantage patients admitted to acute care short stay hospitals.
Show less |
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWR ... outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.
Show more >
This logic is intended to extract electronic clinical data. This is not an electronic clinical quality measure and this logic will not produce measure results. Instead, it will produce a file containing the data that CMS will link with administrative claims to risk adjust the Hybrid HWR outcome measure. It is designed to extract the first resulted set of vital signs and basic laboratory results obtained from hospitalizations for adult Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients admitted to acute care hospitals.
Show less |
| Measure Scoring |
Cohort measure
|
Cohort measure
|
Cohort measure
|
| Stratification |
*See
CMS529v3.html
|
*See
CMS529v4.html
|
None
|
| Risk Adjustment |
*See
CMS529v3.html
|
*See
CMS529v4.html
|
For a detailed description of how the core clinical data elements (CCDEs) are used in the Hybrid HWR measure risk adjustment model, see the Hybrid HWR Measure with Electronic Health Record Extracted Risk Factors Specifications Report on QualityNet here: https://qualitynet.cms.gov/inpatien... t/measures/hybrid/methodology
Show more >
For a detailed description of how the core clinical data elements (CCDEs) are used in the Hybrid HWR measure risk adjustment model, see the Hybrid HWR Measure with Electronic Health Record Extracted Risk Factors Specifications Report on QualityNet here: https://qualitynet.cms.gov/inpatient/measures/hybrid/methodology
Show less |
| Rationale |
*See
CMS529v3.html
|
The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying encounters. The data will be linked with administrative claims to risk adjust the Hybrid HWR outcome measure. This work addresses stakeholder... concerns that clinical data garnered from patients, and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals' case mix. We are calling the list of data elements for extraction the "HWR-specific core clinical data elements". The core clinical data elements are the first set of vital signs and basic laboratory tests resulted from encounters for adult Medicare Fee-For-Service and Medicare Advantage patients, age 65 or older (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. These data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital, 2. are clinically and statistically relevant to patient outcomes, 3. are consistently obtained on adult inpatient encounters based on current clinical practice, 4. are captured with a standard definition and recorded in a standard format across providers, and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHS/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWR measure, which are: CMS Certification Number, Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI), date of birth, sex, admission date, and discharge date.
Show more >
The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying encounters. The data will be linked with administrative claims to risk adjust the Hybrid HWR outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients, and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals' case mix. We are calling the list of data elements for extraction the "HWR-specific core clinical data elements". The core clinical data elements are the first set of vital signs and basic laboratory tests resulted from encounters for adult Medicare Fee-For-Service and Medicare Advantage patients, age 65 or older (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. These data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital, 2. are clinically and statistically relevant to patient outcomes, 3. are consistently obtained on adult inpatient encounters based on current clinical practice, 4. are captured with a standard definition and recorded in a standard format across providers, and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHS/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWR measure, which are: CMS Certification Number, Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI), date of birth, sex, admission date, and discharge date.
Show less |
The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWR outcome measure. This work addresses... stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals' case mix. We are calling the list of data elements for extraction the "HWR-specific core clinical data elements" (CCDE). The CCDE are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 or older (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. These data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital, 2. are clinically and statistically relevant to patient outcomes, 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice, 4. are captured with a standard definition and recorded in a standard format across providers, and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHS/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWR measure, which are: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.
Show more >
The intent of this logic is to extract the FIRST set of clinical data elements from hospital electronic health records (EHRs) for all qualifying hospitalizations. The data will be linked with administrative claims to risk adjust the Hybrid HWR outcome measure. This work addresses stakeholder concerns that clinical data garnered from patients and used by clinicians to guide diagnostic decisions and treatment, are preferable to administrative claims data when profiling hospitals' case mix. We are calling the list of data elements for extraction the "HWR-specific core clinical data elements" (CCDE). The CCDE are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 or older (Initial Population), after they arrive at the hospital to which they are subsequently admitted. For example, this first set of data values are often captured in the emergency department or in the pre-operative area, sometimes hours before a patient is admitted to that same facility. These data elements were selected because they: 1. reflect patients' clinical status when they first present to the hospital, 2. are clinically and statistically relevant to patient outcomes, 3. are consistently obtained during adult inpatient hospitalizations based on current clinical practice, 4. are captured with a standard definition and recorded in a standard format across providers, and 5. are entered in structured fields that are feasibly retrieved from current EHR systems (YNHHS/CORE, 2015). Additional data called Linking Variables are used to link EHR data files with administrative claims data for CMS to calculate results for the Hybrid HWR measure, which are: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.
Show less |
| Clinical Recommendation Statement |
*See
CMS529v3.html
|
*See
CMS529v4.html
|
The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional... measurements or tests that are not needed for diagnostic assessment or treatment of patients.
Show more >
The logic is not meant to guide or alter the care patients receive. The purpose of this CCDE logic is to extract clinical data that are already routinely captured in EHRs from hospitalizations for adult patients. It is not intended to require that clinical staff perform additional measurements or tests that are not needed for diagnostic assessment or treatment of patients.
Show less |
| Improvement Notation |
No actual measure score will be generated by hospitals. Instead, hospitals will report the data values for each of the core clinical data elements for all encounters in the Initial Population. These core clinical data elements will be linked to administrative claims data and used by CMS... to calculate results for the Hybrid HWR measure.
Show more >
No actual measure score will be generated by hospitals. Instead, hospitals will report the data values for each of the core clinical data elements for all encounters in the Initial Population. These core clinical data elements will be linked to administrative claims data and used by CMS to calculate results for the Hybrid HWR measure.
Show less |
No actual measure score will be generated by hospitals. Instead, hospitals will report the data values for each of the core clinical data elements for all encounters in the Initial Population. These core clinical data elements will be linked to administrative claims data and used by CMS... to calculate results for the Hybrid HWR measure.
Show more >
No actual measure score will be generated by hospitals. Instead, hospitals will report the data values for each of the core clinical data elements for all encounters in the Initial Population. These core clinical data elements will be linked to administrative claims data and used by CMS to calculate results for the Hybrid HWR measure.
Show less |
No actual measure score will be generated by hospitals. Instead, hospitals will report the data values for each of the CCDEs for all hospitalizations in the Initial Population. These CCDEs will be linked to administrative claims data and used by CMS to calculate results for the Hybrid... HWR measure.
Show more >
No actual measure score will be generated by hospitals. Instead, hospitals will report the data values for each of the CCDEs for all hospitalizations in the Initial Population. These CCDEs will be linked to administrative claims data and used by CMS to calculate results for the Hybrid HWR measure.
Show less |
| Definition |
*See
CMS529v3.html
|
*See
CMS529v4.html
|
HWR-Specific Core Clinical Data Elements
|
| Guidance |
These specifications are for use for data with discharges that occur between July 1, 2023 and June 30, 2024. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2025.
This logic guides the user to extract the FIRST resulted HWR-specific core clinical... data elements for all Medicare Fee-For-Service encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location.
The logic supports extraction of the FIRST set of HWR-specific core clinical data elements in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility:
1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission.
2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted.
Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.
NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available.
For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes:
Core Clinical Data Element UCUM Unit
Bicarbonate----------------------------------meq/L
mmol/L
Creatinine------------------------------------mg/dL
umol/L
Glucose--------------------------------------mg/dL
mmol/L
Heart rate------------------------------------{Beats}/min
Hematocrit -----------------------------------%
Oxygen saturation (by pulse oximetry)----------%{Oxygen}
Potassium------------------------------------meq/L
mmol/L
Respiratory rate------------------------------{Breaths}/min
Sodium--------------------------------------meq/L
mmol/L
Systolic blood pressure-----------------------mm[Hg]
Temperature---------------------------------Cel
[degF]
Weight---------------------------------------kg
[lb_av]
g
White blood cell count ------------------------{Cells}/uL
10*3/uL
10*9/L
/mm3
For each encounter please also submit the following Linking Variables:
CMS Certification Number,
Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI),
Date of Birth,
Sex,
Inpatient Admission Date, and
Discharge Date.
The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the QDM page for more information on the QDM.
Show more >
These specifications are for use for data with discharges that occur between July 1, 2023 and June 30, 2024. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2025.
This logic guides the user to extract the FIRST resulted HWR-specific core clinical data elements for all Medicare Fee-For-Service encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location.
The logic supports extraction of the FIRST set of HWR-specific core clinical data elements in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility:
1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission.
2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted.
Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements.
NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available.
For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes:
Core Clinical Data Element UCUM Unit
Bicarbonate----------------------------------meq/L
mmol/L
Creatinine------------------------------------mg/dL
umol/L
Glucose--------------------------------------mg/dL
mmol/L
Heart rate------------------------------------{Beats}/min
Hematocrit -----------------------------------%
Oxygen saturation (by pulse oximetry)----------%{Oxygen}
Potassium------------------------------------meq/L
mmol/L
Respiratory rate------------------------------{Breaths}/min
Sodium--------------------------------------meq/L
mmol/L
Systolic blood pressure-----------------------mm[Hg]
Temperature---------------------------------Cel
[degF]
Weight---------------------------------------kg
[lb_av]
g
White blood cell count ------------------------{Cells}/uL
10*3/uL
10*9/L
/mm3
For each encounter please also submit the following Linking Variables:
CMS Certification Number,
Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI),
Date of Birth,
Sex,
Inpatient Admission Date, and
Discharge Date.
The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home.
This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the QDM page for more information on the QDM.
Show less |
These specifications are for use for data with discharges that occur between July 1, 2024 and June 30, 2025. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2026. This logic guides the user to extract the FIRST resulted HWR-specific core clinical data... elements for all Medicare Fee-For-Service and Medicare Advantage encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWR-specific core clinical data elements in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes: Core Clinical Data Element UCUM Unit Bicarbonate----------------------------------meq/L mmol/L Creatinine------------------------------------mg/dL umol/L Glucose--------------------------------------mg/dL mmol/L Heart rate------------------------------------{Beats}/min Hematocrit -----------------------------------% Oxygen saturation (by pulse oximetry)-----%{Oxygen} Potassium------------------------------------meq/L mmol/L Respiratory rate------------------------------{Breaths}/min Sodium---------------------------------------meq/L mmol/L Systolic blood pressure----------------------mm[Hg] Temperature----------------------------------Cel [degF] Weight-----------------------------------------kg [lb_av] g White blood cell count ----------------------{Cells}/uL 10*3/uL 10*9/L /mm3 For each encounter please also submit the following Linking Variables: - CMS Certification Number,
- Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI),
- Date of Birth,
- Sex,
- Inpatient Admission Date, and
- Discharge Date.
The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the eCQI Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Show more >
These specifications are for use for data with discharges that occur between July 1, 2024 and June 30, 2025. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2026. This logic guides the user to extract the FIRST resulted HWR-specific core clinical data elements for all Medicare Fee-For-Service and Medicare Advantage encounters for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient location. The logic supports extraction of the FIRST set of HWR-specific core clinical data elements in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for core clinical data element values related to a patient who is subsequently admitted. Value sets for the laboratory tests represent the LOINC codes currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the core clinical data elements. NOTE: Do not report ALL values on an encounter during their entire admission. Only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. For each core clinical data element, please report values using one of the appropriate units of measurement listed below, which represent valid UCUM codes: Core Clinical Data Element UCUM Unit Bicarbonate----------------------------------meq/L mmol/L Creatinine------------------------------------mg/dL umol/L Glucose--------------------------------------mg/dL mmol/L Heart rate------------------------------------{Beats}/min Hematocrit -----------------------------------% Oxygen saturation (by pulse oximetry)-----%{Oxygen} Potassium------------------------------------meq/L mmol/L Respiratory rate------------------------------{Breaths}/min Sodium---------------------------------------meq/L mmol/L Systolic blood pressure----------------------mm[Hg] Temperature----------------------------------Cel [degF] Weight-----------------------------------------kg [lb_av] g White blood cell count ----------------------{Cells}/uL 10*3/uL 10*9/L /mm3 For each encounter please also submit the following Linking Variables: - CMS Certification Number,
- Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI),
- Date of Birth,
- Sex,
- Inpatient Admission Date, and
- Discharge Date.
The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the eCQI Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Show less |
These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027. This logic guides the user to extract the FIRST resulted HWR-specific CCDEs for all... Medicare FFS and MA hospitalizations for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient/same day surgery location. The logic supports extraction of the FIRST set of HWR-specific CCDE in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for CCDE values related to a patient who is subsequently admitted. For weight, the logic supports extraction of the FIRST resulted vital sign recorded during the hospitalization, which may be prior to, or during admission. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the CCDEs. NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation. For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any units may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and the median value reported for that CCDE will be imputed. CCDE UCUM Units Bicarbonate-------------------------------------meq/L mmol/L Creatinine---------------------------------------mg/dL Glucose------------------------------------------mg/dL mmol/L - Heart rate---------------------------------------{Beats}/min Hematocrit --------------------------------------% Oxygen saturation (by pulse oximetry)- -%{Oxygen} Potassium----------------------------------------meq/L mmol/L Respiratory rate---------------------------------{Breaths}/min Sodium--------------------------------------------meq/L mmol/L Systolic blood pressure-----------------------mm[Hg] Temperature-------------------------------------Cel [degF] Weight---------------------------------------------kg [lb_av] g White blood cell count -----------------------{Cells}/uL 10*3/uL 10*9/L For each hospitalization please also submit the following Linking Variables: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the QDM page for more information on the QDM.
Show more >
These specifications are for use for data with discharges that occur between July 1, 2025 and June 30, 2026. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2027. This logic guides the user to extract the FIRST resulted HWR-specific CCDEs for all Medicare FFS and MA hospitalizations for patients age 65 or older (Initial Population) directly admitted to the hospital or admitted to the same facility after being treated in another area such as the emergency department or hospital outpatient/same day surgery location. The logic supports extraction of the FIRST set of HWR-specific CCDE in two different ways depending on if the patient was a direct admission, meaning that the patient was admitted directly to an inpatient unit without first receiving care in the emergency department or other hospital outpatient locations within the same admitting facility: 1. If the patient was a direct admission, the logic supports extraction of the FIRST resulted vital signs (physical exams) within 2 hours (120 minutes) after the start of the inpatient admission, and the FIRST resulted laboratory tests within 24 hours (1440 minutes) after the start of the inpatient admission. 2. If the patient has values captured prior to admission, for example from the emergency department, pre-operative, or other outpatient area within the hospital, the logic supports extraction of the FIRST resulted vital signs and laboratory tests within 24 hours (1440 minutes) PRIOR to the start of the inpatient admission. All clinical systems used in inpatient and outpatient locations within the hospital facility should be queried when looking for CCDE values related to a patient who is subsequently admitted. For weight, the logic supports extraction of the FIRST resulted vital sign recorded during the hospitalization, which may be prior to, or during admission. Value sets for the laboratory tests are represented using Logical Observation Identifiers Names Codes (LOINC) currently available for these tests. If the institution is using local codes to capture and store relevant laboratory test data, those sites should map that information to the LOINC code for reporting of the CCDEs. NOTE: It is recommended hospitals only report the FIRST resulted value for EACH core clinical data element collected in the appropriate timeframe, if available. Hospitals may also choose to report ALL values on an encounter during their entire admission; however, only the first resulted values are utilized in the logic for measure calculation. For each CCDE, it is recommended that hospitals report the below Unified Code for Units of Measure (UCUM) units, however, any units may be submitted. Where the reported unit is not easily converted to the requested UCUM units, the value will be set to missing and the median value reported for that CCDE will be imputed. CCDE UCUM Units Bicarbonate-------------------------------------meq/L mmol/L Creatinine---------------------------------------mg/dL Glucose------------------------------------------mg/dL mmol/L - Heart rate---------------------------------------{Beats}/min Hematocrit --------------------------------------% Oxygen saturation (by pulse oximetry)- -%{Oxygen} Potassium----------------------------------------meq/L mmol/L Respiratory rate---------------------------------{Breaths}/min Sodium--------------------------------------------meq/L mmol/L Systolic blood pressure-----------------------mm[Hg] Temperature-------------------------------------Cel [degF] Weight---------------------------------------------kg [lb_av] g White blood cell count -----------------------{Cells}/uL 10*3/uL 10*9/L For each hospitalization please also submit the following Linking Variables: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date. The initial population includes patients with inpatient hospitalizations and patients from Acute Hospital Care at Home programs, who are treated and billed as inpatients but receive care in their home. This version of the specifications uses Quality Data Model (QDM) version 5.6. Please refer to the QDM page for more information on the QDM.
Show less |
| Initial Population |
All Medicare Fee-For-Service encounters age 65 and older at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days).
NOTE: All Medicare Fee-For-Service encounters meeting the above criteria should be included, regardless if... Medicare Fee-For-Service is the primary, secondary, or tertiary payer.
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All Medicare Fee-For-Service encounters age 65 and older at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days).
NOTE: All Medicare Fee-For-Service encounters meeting the above criteria should be included, regardless if Medicare Fee-For-Service is the primary, secondary, or tertiary payer.
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All Medicare Fee-For-Service and Medicare Advantage encounters for patients aged 65 and older at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days). NOTE: All Medicare Fee-For-Service and Medicare Advantage encounters meeting... the above criteria should be included, regardless of whether Medicare Fee-For-Service/Medicare Advantage is the primary, secondary, or tertiary payer.
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All Medicare Fee-For-Service and Medicare Advantage encounters for patients aged 65 and older at the start of an inpatient admission, who are discharged during the measurement period (length of stay <365 days). NOTE: All Medicare Fee-For-Service and Medicare Advantage encounters meeting the above criteria should be included, regardless of whether Medicare Fee-For-Service/Medicare Advantage is the primary, secondary, or tertiary payer.
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All Medicare FFS and MA hospitalizations for patients aged 65 and older at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period. NOTE: All Medicare FFS and MA hospitalizations meeting the above... criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.
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All Medicare FFS and MA hospitalizations for patients aged 65 and older at the start of an inpatient admission, where the length of stay is less than 365 days, and the hospitalization ends during the measurement period. NOTE: All Medicare FFS and MA hospitalizations meeting the above criteria should be included, regardless of whether Medicare FFS/MA is the primary, secondary, or tertiary payer.
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