2024 Reporting PeriodCMS844v4Hybrid HWM]]>3502eThis 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 HWM 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.

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All Medicare Fee-For-Service and Medicare Advantage encounters for patients aged 65 to 94 years 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.

]]>Centers for Medicare & Medicaid Services (CMS)]]>Cohort]]>

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 HWM measure.

]]>

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 HWM 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 "HWM-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 to 94 (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. Encounters over the age of 94 are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include encounters between 65 and 94 years of age.

These core clinical 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 (YNHHSC/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 HWM 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.

]]>2025 Reporting PeriodCMS844v5Hybrid HWM

]]>3502eThis 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 HWM 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.

]]>HWM-Specific Core Clinical Data Elements

]]>All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years 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.

]]>Centers for Medicare & Medicaid Services (CMS)]]>Cohort]]>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 core clinical data elements will be linked to administrative claims data and used by CMS to calculate results for the Hybrid HWM measure.

]]>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 HWM 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 "HWM-specific core clinical data elements" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (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.

Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age.

These CCDEs 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 (YNHHSC/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 HWM measure, which are: CMS Certification Number (CCN); National Provider Identifier (NPI) for MA patients; Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.

]]>None

]]>For a detailed description of how the core clinical data elements (CCDEs)are used in the Hybrid HWM measure risk adjustment model, see the Hybrid HWM Measure Methodology Report on CMS.gov here: https://qualitynet.cms.gov/inpatient/measures/hybrid/methodology

]]>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.

]]>

Hospitals are not required to submit NPI for Medicare Advantage patients as long as CCN is submitted.

]]>2026 Reporting PeriodCMS844v6Hybrid HWM

]]>3502eThis 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 HWM 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.

]]>HWM-Specific Core Clinical Data Elements

]]>All Medicare FFS and MA hospitalizations for patients aged 65 through 94 years 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.

]]>Centers for Medicare & Medicaid Services (CMS)]]>Cohort]]>Outcome]]>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 HWM measure.

]]>The intent of this logic is to extract the FIRST valid 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 HWM 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 "HWM-specific core clinical data elements" (CCDE). The CCDEs are the first set of vital signs and basic laboratory tests resulted from hospitalizations for adult Medicare FFS and MA patients, age 65 through 94 years (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.

Hospitalizations over the age of 94 years are not included to avoid holding hospitals responsible for the survival of the oldest elderly patients, who may be less likely to have survival as a primary goal. While we acknowledge that many elderly patients do have survival beyond 30 days as a primary goal for their hospitalization, with input from our Technical Expert Panel and work groups, we decided to only include hospitalizations between 65 and 94 years of age.

These CCDEs 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 (YNHHSC/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 HWM measure, which are: CMS Certification Number (CCN); Medicare Beneficiary Identifier (MBI); Inpatient Admission Date; and Discharge Date.

]]>None

]]>For a detailed description of how the core clinical data elements (CCDEs)are used in the Hybrid HWM measure risk adjustment model, see the Hybrid HWM Measure Methodology Report on CMS.gov here: https://qualitynet.cms.gov/inpatient/measures/hybrid/methodology

]]>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.

]]>