| 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 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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| Guidance |
These specifications are for use for data with discharges that occur between July 1, 2021 and June 30, 2022. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2023.
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 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.
This version of the specifications uses Quality Data Model (QDM) version 5.5. Please refer to the Electronic Clinical Quality Improvement (eCQI) Resource Center for more information on the QDM.
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These specifications are for use for data with discharges that occur between July 1, 2022 and June 30, 2023. The associated Hospital Specific Report (HSR) is anticipated to be released in Spring 2024.
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 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.
This version of the specifications uses Quality Data Model (QDM) version 5.5. Please refer to the Electronic Clinical Quality Improvement (eCQI) Resource Center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
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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.
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