DSRIP Performance Measurement Databook v4.1 Draft... · 2018-08-13 · This databook includes eighty‐one DSRIP measures and is divided between measures collected using Medicaid

June2018,Version4.1 Page1of236PreparedbyMyersandStaufferLC

NewJerseyDeliverySystemReformIncentive

Payment(DSRIP)Program

DSRIPPerformance

MeasurementDatabook

June 2018,v4.1

PreparedbyMyersandStaufferLC

NewJerseyDSRIPPerformanceMeasurementDatabook


TableofContents

I. GeneralOverview...................................................................................................................................................................................4II. AttributionMethodology...........................................................................................................................................................2322III. SamplingMethodology.................................................................................................................................................................2928IV. SpecificationSheetDescriptionandDefinitions...............................................................................................................3130V. RelatedDocumentsavailableathttps://dsrip.nj.gov/Home/Resources

a. AppendixA‐MasterList b. AppendixA‐ValueSets‐Codesc. AppendixA‐ValueSets‐Medictionsd. AppendixA‐DY7‐DY8Stage1ValueSets‐Codese. AppendixB‐PlannedReadmissionCodesf. AppendixC‐ProgrammingAssumptiong. AppendixD‐DY6toDY7‐DY8MeasuresCrosswalkh. AddendumtoDatabook‐DY7‐DY8Stage1SystemTransformationMeasuresUpdate

Chart/ElectronicHealthRecordPerformanceMeasurementSpecifications1. AntenatalSteroidsDSRIPCode10..............................................................................................................................................37343. BipolarDisorderandMajorDepression:AppraisalforalcoholorchemicalsubstanceuseDSRIPCode

15................................................................................................................................................................................................................40374. CAC‐1:RelieversforInpatientAsthmaDSRIPCode17......................................................................................................43405. CAC‐2:SystemicCorticosteroidsforInpatientAsthmaDSRIPCode18.....................................................................46436. Cardiovascularhealthscreeningforpeoplewithschizophreniaorbipolardisorderwhoareprescribed

antipsychoticmedicinesDSRIPCode94..................................................................................................................................49467. CentralLine‐AssociatedBloodstreamInfection(CLABSI)EventDSRIPCode21..................................................51488. CesareanRateforNullipariousSingletonVisitsDSRIPCode23....................................................................................54519. ChildrenAge6–17YearswhoEngageinWeeklyPhysicalActivityDSRIPCode26...........................................565310.ComprehensiveDiabetesCare:LDL‐CControl<100mg/DLDSRIPCode30...........................................................585511.ControllingHighBloodPressure(CBP)DSRIPCode31....................................................................................................615812.DepressionRemissionat12MonthsDSRIPCode33..........................................................................................................646113.DiabetesMellitus:DailyAspirinorAnti‐plateletMedicationUseforPatientswithDiabetesandIschemic

VascularDiseaseDSRIPCode100...............................................................................................................................................666314.ElectiveDeliveryDSRIPCode37..................................................................................................................................................686515.EmergencyMedicine:Community‐AcquiredPneumonia(CAP):AssessmentofMentalStatusDSRIPCode

69................................................................................................................................................................................................................716816.EyeExaminationDSRIPCode39..................................................................................................................................................737017.FootExaminationDSRIPCode43................................................................................................................................................767318.HeartFailure:Angiotensin‐ConvertingEnzyme(ACE)InhibitororAngiotensinReceptorBlocker(ARB)

TherapyforLeftVentricularSystolicDysfunction(inpatientsetting)DSRIPCode9..........................................787519.HospitalAcquiredPotentiallyPreventableVenousThromboembolismDSRIPCode47...................................817820.InitialAntibioticSelectionforCommunity‐AcquiredPneumonia(CAP)inImmunocompetentPatientDSRIP

Code51....................................................................................................................................................................................................838021.IschemicVascularDisease(IVD):CompleteLipidProfileandLDL‐CControl<100mg/dLDSRIPCode

55................................................................................................................................................................................................................878422.LeftVentricularEjectionFraction(LVEF)AssessmentDSRIPCode57.....................................................................898623.LipidManagementDSRIPCode58..............................................................................................................................................918824.MajorDepressiveDisorder(MDD):SuicideRiskAssessmentDSRIPCode59........................................................939025.MedicalattentionfornephropathyDSRIPCode98.............................................................................................................959226.MedicationReconciliationDSRIPCode61...............................................................................................................................999627.PediatricCentral‐LineAssociatedBloodstreamInfections(CLABSI)‐NeonatalIntensive‐CareUnitand

PediatricIntensiveCareUnitDSRIPCode63......................................................................................................................10198



28.PercentofhospitalizedpatientswhoarescreenedduringthehospitalstayusingavalidatedscreeningquestionnaireforunhealthyalcoholuseDSRIPCode64.............................................................................................103100

29.Percentofpatientsevaluatedforenvironmentaltriggersotherthanenvironmentaltobaccosmoke(dustmites,cats,dogs,molds/fungi)DSRIPCode65................................................................................................................105102

30.Percentageofpatientsagedgreaterthanorequalto18yearsdiagnosedwithcommunity‐acquiredbacterialpneumoniawhohadachestx‐rayDSRIPCode70..........................................................................................................107104

31.PercentageofpatientswithBMI>=25whosetanindividualizedgoalalongwithtargetdateforreductioninbodymassindexDSRIPCode71.............................................................................................................................................109106

32.Post‐DischargeAppointmentforHeartFailurePatientsDSRIPCode73.............................................................11110833.PostoperativeSepsisDSRIPCode74.....................................................................................................................................11411134.PreventiveCareandScreening:TobaccoUse:ScreeningandCessationInterventionDSRIPCode76...11611335.ScreeningforClinicalDepressionandFollow‐upPlanDSRIPCode79.................................................................11911636.SubstanceUseDisorders:ScreeningforDepressionAmongPatientswithSubstanceAbuseorDependence

DSRIPCode68.................................................................................................................................................................................12111837.TimelyTransmissionofTransitionRecordDSRIPCode80........................................................................................12312038.WeightAssessmentandCounselingforNutritionandPhysicalActivityforChildren/AdolescentsDSRIP

Code87...............................................................................................................................................................................................126123MMISPerformanceMeasurementSpecifications1. 30‐DayAll‐CauseReadmissionFollowingAcuteMyocardialInfarction(AMI)HospitalizationDSRIPCode

1 1311282. 30‐DayAll‐CauseReadmissionFollowingChronicObstructivePulmonaryDisease(COPD)Hospitalization

DSRIPCode2....................................................................................................................................................................................1341313. 30‐DayAll‐CauseReadmissionFollowingHeartFailure(HF)HospitalizationDSRIPCode3....................1371344. 30‐DayAll‐CauseReadmissionFollowingPneumoniaHospitalizationDSRIPCode4...................................1401376. AdherencetoChronicMedicationsforPeoplewithDiabetesMellitus:HypoglycemicAgentsDSRIPCode

97...........................................................................................................................................................................................................1431407. AdherencetoChronicMedicationsforPeoplewithDiabetesMellitus:StatinsDSRIPCode96.................1461438. AdolescentWell‐CareVisitDSRIPCode5...........................................................................................................................1491469. AdultAsthmaAdmissionRateDSRIPCode6....................................................................................................................15114810.AdultBodyMassIndex(BMI)assessmentDSRIPCode7............................................................................................15315011.AmbulatoryCare–EmergencyDepartmentVisitsDSRIPCode8............................................................................15515212.AntidepressantMedicationManagement–EffectiveAcutePhaseTreatmentDSRIPCode11..................15715413.AntidepressantMedicationManagement–EffectiveContinuationPhaseTreatmentDSRIPCode12

16015714.AsthmaadmissionrateDSRIPCode13................................................................................................................................16316015.AsthmainYoungerAdultsAdmissionDSRIPCode14..................................................................................................16516216.AsthmaMedicationRatioDSRIPCode90...........................................................................................................................16716417.BreastCancerScreeningDSRIPCode16.............................................................................................................................17016718.CD4T‐CellCountDSRIPCode20............................................................................................................................................17216919.CervicalCancerScreeningDSRIPCode22..........................................................................................................................17417121.ChildImmunizationStatusDSRIPCode25........................................................................................................................17617322.ChildrenandAdolescents’AccesstoPrimaryCarePractitionersDSRIPCode27............................................18017723.ChlamydiaScreeninginWomenDSRIPCode28.............................................................................................................18217924.ComprehensiveDiabetesCare(CDC):HemoglobinA1c(HbA1c)testingDSRIPCode29............................18418125.COPDAdmissionRateDSRIPCode32..................................................................................................................................18618326.DiabetesLong‐TermComplicationsAdmissionRateDSRIPCode34....................................................................18818527.DiabetesMonitoringforPeoplewithDiabetesandSchizophreniaDSRIPCode92.........................................19018728.Diabetesscreeningforpeoplewithschizophreniaorbipolardisorderwhoareusingantipsychotic

medications(SSD)DSRIPCode35.........................................................................................................................................19319029.DiabetesShort‐TermComplicationsAdmissionRateDSRIPCode36...................................................................19619330.EngagementofalcoholandotherdrugtreatmentDSRIPCode38..........................................................................19819531.Follow‐upAfterHospitalizationforMentalIllness–30dayspostdischargeDSRIPCode40....................20119832.Follow‐upAfterHospitalizationforMentalIllness–7dayspostdischargeDSRIPCode41.......................20420133.Follow‐upCareforChildrenPrescribedADHDMedicationDSRIPCode42.......................................................207204



35.HeartFailureAdmissionRateDSRIPCode45..................................................................................................................21020736.HemoglobinA1c(HbA1c)TestingforPediatricPatientsDSRIPCode46.............................................................21220937.HypertensionAdmissionRateDSRIPCode48..................................................................................................................21421138.InitiationofalcoholandotherdrugtreatmentDSRIPCode52.................................................................................21621340.MedicationManagementforPeoplewithAsthma–75%DSRIPCode60............................................................22021641.MentalHealthUtilizationDSRIPCode62............................................................................................................................22422042.PercentofpatientswhohavehadavisittoanEmergencyDepartment(ED)forasthmainthepastsix

monthsDSRIPCode66................................................................................................................................................................22622243.PercentageofLiveBirthsWeighingLessthan2,500gramsDSRIPCode67.......................................................22822444.UncontrolledDiabetesAdmissionRateDSRIPCode81...............................................................................................23022645.UseofAppropriateMedicationsforPeoplewithAsthmaDSRIPCode83............................................................23222846.Well‐ChildVisitsinFirst15MonthsofLifeDSRIPCode88........................................................................................235231

I. GeneralOverview

A. Background

TheDeliverySystemReformIncentivePayment(DSRIP)programisonecomponentoftheNewJersey’sComprehensive1115WaiverasapprovedbytheCentersforMedicare&MedicaidServices(CMS).DSRIPisademonstrationprogramdesignedtoaddressthethreepartaimforbettercareforindividuals(includingaccesstocare,qualityofcare,healthoutcomes),betterhealthforthepopulation,andlowercoststhroughtheachievementofhealthimprovementgoals.Incentivepaymentawardsareavailabletohospitalscontingentonhospitals’fullymeetingperformanceandoutcomemetrics.ThisNewJerseyDSRIPPerformanceMeasurementDatabook(otherwisereferredtoasthe“databook”)providesthespecificationsfortheDSRIPclinicalperformancemeasureset.Thisincludesthemeasures’numerator,denominator,associatedCurrentProceduralTerminology(CPT)codes,InternationalClassificationofDiseases,ClinicalModification(ICD‐09‐CMandICD‐10‐CM)diagnosescodesandAllPatientsDiagnosesRelatedGroups(AP‐DRG)alongwiththemeasures’reportingrequirementsandincentivepaymentimpact.Abroadmeasuresetisrepresentedinordertomonitortheinfluenceofproject‐specificclinicalinterventionsalongwiththegeneralpopulationhealthoftheDSRIPpopulation.Specifically,theDSRIPprogramwillmeasurethehealthoftheNewJerseyMedicaid,Children’sHealthInsuranceProgram(CHIP)andCharityCarepopulations,collectivelyreferredtoasthe“NewJerseyLowIncomepopulation.”Thisincludesthefee‐for‐service,managedcareandduallyeligiblesub‐populations.TheDSRIPmeasuresetassessesclinicalperformanceintheoutpatientsetting,inpatientsetting,andacrosssettingsofcare.Thisdatabookincludeseighty‐oneDSRIPmeasuresandisdividedbetweenmeasurescollectedusingMedicaidManagementInformationSystem(MMIS)administrativeclaimsdataandthosethatusethechart/electronichealthrecord(EHR)datacollectionprocedures.



ForupdatestotheNJDSRIPprograminDY7‐DY8,therearesomeadditionaldocumentstosupportthisDatabookv4.1.Theyinclude:

AddendumtoDatabook–DY7‐DY8SystemTransformationMeasures:ThisAddendumincludesthemeasurespecficationsforthetennewmeasuresinDY7‐DY8Stage1.

AppendixADY7‐DY8Stage1ValueSetsCodes:AcomplementarydocumenttotheAddendumthatlistsanynewDY7‐DY8Stage1valuesetsandcodesnotincludedintheAppendixA–ValueSetsdocument.

AppendixD–DY6toDY7‐DY8MeasuresCrosswalk:AcrosswalkthatlistsallthemeasuresincludedinDY7‐DY8,andhighlightsanychangesmadetothemeasures(applicablestage,paymenttype,andcurrentstatus)fromDY6.

AllofthesedocumentscanbefoundontheNJDSRIPResorucespage:https://dsrip.nj.gov/Home/Resources.1. MMISMeasures–Administrativeclaimsdata

OneprimarymethodtomeasureperformanceisthroughthecollectionofrelevantadministrativeclaimsdatawhichissubmittedforpaymenttotheNewJerseyDepartmentofMedicalAssistanceandHumanServices(DMAHS).InordertomeasureclinicalperformanceacrosssettingsofcarefortheNewJerseyLowIncomepopulation,theDepartment,withCMSapproval,agreedtocalculatecertainDSRIPmeasuresonthebehalfofDSRIPparticipatinghospitals.ThisadministrativeclaimsdataiscollectedandadjudicatedintheNewJerseyMedicaidManagementInformationSystem(MMIS).ThedataiscopiedandtransferredfordatastoragetoadatawarehousemanagedbyaDMAHSvendor.Theadministrativeclaimsdatacapturespatientutilizationthatcanbeusedtomeasurequalityperformance.Itreliesheavilyonmeasuringtheoccurrenceofaservice(orlackofoccurrence).Thisincludesinformationforallservicesreceivedandsubmittedforpaymentforallprovidertypes.ThisclaimadjudicationinformationisthenprovidedtotheCentersforMedicare&MedicaidServices(CMS)andretainedinthefederalMedicaidStatisticalInformationSystem(MSIS)datawarehouse.Collectionofadministrativeclaimsdataalonecanbeincompleteforperformancemeasurementifpertinentclinicalinformationismissing.Iftheclinicalinformationisnotrequiredforprocessingthepaymentoftheservice,thedatamaynotbesubmittedontheclaimortheinformationmaynotbecapturedduringtheclaimsadjudicationprocess.Forthatreason,acollectionmethodthatincludesthereviewofpatientmedicalrecordchartsisveryvaluableinqualitymeasurementandisincludedintheDSRIPprogram.

2. Chart/EHRMeasures–Medicalrecorddata



Patientmedicalrecordsmaybeeitherintheformofapaperrecord,oranelectronichealthrecord(EHR).Medicalrecordabstractionisacollectionmethodthatrequirestheretrospectivegatheringofinformationthrougheitheradirectreviewofapatient’schart,orbyrunningadataqueryofanEHRsystem.Thecollectionofdatathroughthereviewofpatientchartscanberesourceintensive.Tominimizethisconcern,usingstatisticallyvalidsamplingprocedurestofindrepresentativepatientcaseswillbeacceptedfortheDSRIPmeasurementprocess.EHRsystemsarereducingtheburdenofretrospectivereviews.DSRIPprovidersmayfindthatperformingadataqueryoftheirEHRsystemwillmoreefficientlyidentifypatientsthatmeetmeasurecriteria.However,EHRsystemsmayalsobeincompleteifmeasuredatapointsarenotrequireddataentryelementsandremainunavailable.Inordertoreducethepopulationselection,ahospitalmayrelyonbothmethods:asystemssolutionincombinationwithachartreview.Adataquerycanfirstberuntoidentifywhetherpatientsmeetspecificmeasurecriteria,andthenamanualmethodcanbeusedtofurtherlocateadditionaldatapointsdocumentedinthechart.

B. DSRIPIncentiveImpact

EachStage3andStage4measurehasanimpacttohospitalpaymentawardvaluation.Awardisbasedoneitherapayforreporting(P4R)basis,orapayforperformance(P4P)basis.Ashospitalscompleteinfrastructureactivitiesoverthecourseofthewaiver,agreaterportionoftheDSRIPmoniestransitiontopaymentbasedonperformancemeasurement.TableI.STAGE3and4DEMONSTRATIONYEAR(DY)FUNDINGPERCENTAGE

Stages DY3 DY4 DY53 15% 35% 50%4 10% 15% 25%

Foreachofthefinaltwodemonstrationyears(DY),awardwillbebasedonmeasurableimprovementinacoresetofthehospitals’Stage3performancemeasuresmarkedasP4P.Ameasurableimprovementisconsideredtobeaminimumofatenpercentreductioninthedifferencebetweenthehospital’sbaselineperformanceandadefinedimprovementtargetgoal(ITG).

TableII.DSRIPPAYFORPERFORMANCEIMPROVEMENTCALCULATION

Line1 ImprovementTargetGoal(ITG)

Line2BetteroftheHospitalRateinthepriorperformanceperiodortheExpected

ImprovementTarget(Baseline)

Line3Subtractthehospital’srate(line2)fromtheimprovementtargetgoal(line1).Thisisthegapbetweenthehospital’spriorperformanceperiodrateandtheimprovementtargetgoal.(Gap)



Line4 Requiredannualreductioninthegap(10%)

Line5 Multiplythegap(line3)bythe10%requiredannualreductioninthegap(line4).Thisresultsintherateofimprovementrequired.

Line6Addthehospital’sbaselinerate(line2)totherateofimprovement(line5).(ExpectedImprovementTarget)

Line7

CompareExpectedImprovementTargettoActualPerformanceResult;IstheActualPerformanceResultattheImprovementTargetGoal?IstheActualPerformanceResultattheExpectedImprovementTarget?IfeitherisYes–thenthePaymentIncentiveisAwarded.

ForanymeasurethattheDepartmentdetermines,withCMSconcurrence,thattheabovecalculationcannotbecomputed,theDepartmentwillauthorizeasimpletenpercentrateofimprovementoverthehospital’sbaselineperformancerateperyearastheExpectedImprovementTargetforthatmeasure.ThismayoccurifthereisinsufficientdatatodevelopaNewJerseyLowIncomeImprovementTargetGoal,orifnationalbenchmarkingdataisunavailable.AhospitalmayqualifyforagapreductionincentivethatadjuststhetenpercentreductiontoaneightpercentreductionifthehospitalelectstoincludeintheirDSRIPnetwork:1)asingle,orcollectionofcommunity‐basedreportingpartners,whoholdapatientrosterofnotlessthan1,000uniqueNJLowincomepatients,or2)anenhancedreportingpartner.Acommunity‐basedreportingpartnerisdefinedasapartnerwho:

1. Isnotahospital‐basedclinicthatbillsunderthehospital’sprovideridentifierwithspecifiedrevenuecodes510‐519.

2. IsaMedicaid‐enrolledclinic,facility,orphysicianpracticegroupthatcan/willcomplywithreportingoutpatientdata.

3. AgreestosupporttheobjectivesoftheDSRIPprogram.4. Mayhaveanexistingemploymentrelationshiporownershipwiththehospital/

hospitalsystem.5. Has/willhaveaDataUseAgreement,orotherformaldatasharingarrangementin

placebyOctober1,2014(DY3).Anenhancedreportingpartnerisdefinedasapartnerwho:

1. IsaMedicaid‐enrolledclinic,facility,orphysicianpracticegroupthatcan/willcomplywithreportingoutpatientdata.

2. AgreestosupporttheobjectivesoftheDSRIPprogram.3. DoesNOThaveanexistingemploymentrelationshiporownershipwiththe

hospital/hospitalsystem.4. WillhaveDataUseAgreement,orotherformaldatasharingarrangementinplaceby

July1,2015(DY4).



HospitalsshouldrefertotheFundingandMechanicsProtocol(FMP)forfurtherinformation.1. ImprovementTargetGoals(ITG)

AsoutlinedintheFMP,theimprovementtargetgoalservesasthestandardlevelofperformancethatNewJerseyhospitalswillstrivetoobtain.InordertoselecttheNewJerseyLowIncomeImprovementTargetGoal,baselineresultswereidentifiedforallStage3measures.ForanygivenmetricthathadinsufficientdatatocompileaNewJerseyLowIncomeImprovementTargetGoal,itwasdeterminedwhetherpublicallyavailabledatawasavailable(e.g.national,Medicare‐only,orcommercial)thatcouldbeusedasasubstitution.Inordertosetmeasure‐specificITGs,NewJerseysetgoalsusingthefollowingbenchmarkhierarchyforeachmeasure:

1. Utilizethe90thor75thpercentileofDSRIP‐participatinghospitals,if10ormorehospitalresults,ifavailable.

2. Utilizethe95thpercentileofnationalNewJerseystatewidedata,ifavailable.3. Utilizethe95thpercentileofnationaldata,ifavailable.4. Utilizea90%compliancebenchmarkforprocessmeasures.

TheapprovedimprovementtargetgoalandthecalculatedexpectedimprovementtargetgoalforeachP4PmeasureisaccessibletothehospitalsviatheNewJerseyDSRIPwebportalloginat:https://dsrip.nj.gov/.

C. MeasureStewards

TheDY6Stage3andStage4performancemeasureswereselectedbasedontheirendorsementbyrespectednationalhealthcarebodiesandtheirbroadusageforcomparingqualityperformance.Thehealthcareentitythatdevelopedthemeasureisreferredtoasthemeasuresteward.Themeasurestewardactsasthe“owner”ofthemeasureandistheentitythatsoughtandreceivednationalmeasureendorsement.

Itisimportanttonotethatthemeasurestewardisresponsibleformaintainingthedetaileddescriptionofthemeasure.Measuredescriptionsthataremadeavailabletothepublicbasedonnationalendorsementincludesuchdataelementsasthenumeratoranddenominatorspecifications,standarderrorrates,algorithms,groupers,andriskadjustmentmethodologies,asapplicable.Nationalendorsementallowsforopenreplicationofthemeasureforcomparativepurposesbyotherhealthcareentitiesprovidedthattherequiredcitationsaremet(SeeSectioniibelowforsuchcitations).ThemeasurestewardisidentifiedforeachmeasurewithintheDSRIPspecificationsheet,aswellasthePlanningProtocolAddendums1and2.

ThemeasurestewardsthatarerepresentedwithintheDSRIPprograminclude:



1. AgencyforHealthcareResearchandQuality(AHRQ)2. AmericanMedicalAssociation–PhysicianConsortiumforPerformance

Improvement(AMA‐PCPI)3. CentersforDiseaseControlandPrevention(CDC)4. CentersforMedicare&MedicaidServices(CMS)5. CenterforQualityAssessmentandImprovementinMentalHealth(CQAIMH)6. HealthResourcesandServicesAdministration(HRSA)7. InstituteforClinicalSystemsImprovement(ICSI)8. MinnesotaCommunityMeasurement(MNCM)9. NationalCommitteeforQualityAssurance(NCQA)10. TheJointCommission

Generally,themeasurespecificationshavebeenfollowedandsummarizedwithinthisdatabook.Insomeinstances,ithasbeennecessarytoadjustthemeasurestewards’specificationsinordertomorecloselyaligntothepopulationandmonitoringgoalsoftheDSRIPprogram.ThemeasurespecificationswithinthisdocumentarethoseofthemeasurestewardunlesssuchDSRIPchangeswererequired.

i. MeasureStewardSpecificationVersion

Aseachmeasurestewardisresponsibleforthemaintenanceofthemeasure(s)theydevelop,eachstewardmayfollowdifferentmaintenanceschedules.ToensureconsistentusagebyDSRIPproviders,theDSRIPprogramwillutilizethemostrecentfinalizedversionmadepubliclyavailablepriortoOctober15ofeachcalendaryear.Thedatabookwillthenbeupdatedandanewversionmadeavailable.

Forexample,theNationalCommitteeforQualityAssurance(NCQA)freezestheupdatesfortheirHEDIS®manualasofOctober1theyearpriortotheyearofthetitledversion.TheHEDIS®2013Volume2,TechnicalSpecificationsforHealthPlanswasmadeavailableasofOctober1,2012.ThestandardspecificationsapplytothepreviouscalendaryearandresultsmustbesubmittedtoNCQAbyJune2013inordertobeavailableforpublicreporting.

WithintheDSRIPspecificationsections,themeasurestewardspecificationversionisidentifiedforeachmeasureforreference.

Note:Whenanupdatefromameasurestewardwouldsignificantlychangetheresultsofameasureforwhichbaselineswereset,theoriginalversionofthemeasurespecificationwillbemaintainedforthedurationoftheDSRIPproject.

ii. MeasureStewardCitations–Thefollowingcitationappliestoeverymeasureassociatedwiththenamedmeasuresteward:AmericanMedicalAssociationUsedwithpermission.



CenterforQualityAssessmentandImprovementinMentalHealth(CQAIMH)Thismeasureisbeingusedfollowingthe2007copyrightspecificationsoftheCenterforQualityAssessmentandImprovementinMentalHealth(CQAIMH)andinaccordancewiththeendorsementbytheNationalQualityForum(NQF).InstituteforClinicalSystemsImprovement(ICSI)Copyright2013byInstituteforClinicalSystemsImprovement.Usedwithpermission.NationalCommitteeforQualityAssurance(NCQA)MeasurecontenthasbeensourcedfromtheHEDIS,Volume2,TechnicalSpecificationsforHealthPlansbytheNationalCommitteeforQualityAssurance(NCQA)andmodifiedbyNewJerseyDepartmentofHealthDeliverySystemReformIncentivePayment(DSRIP)program.HEDIS®isaregisteredtrademarkoftheNationalCommitteeforQualityAssurance(NCQA).NCQAhasneitherreviewednorapprovedthesemodifiedmeasures.TheJointCommissionTheSpecificationsManualforNationalInpatientQualityMeasures[]isthecollaborativeworkoftheCentersforMedicare&MedicaidServicesandTheJointCommission.TheSpecificationsManualisperiodicallyupdatedbytheCentersforMedicare&MedicaidServicesandTheJointCommission.UsersoftheSpecificationsManualforNationalHospitalInpatientQualityMeasuresmustupdatetheirsoftwareandassociateddocumentationbasedonthepublishedmanualproductiontimelines.



D. DataReportingandCalculationMethods:

AsdiscussedinSectionA.above,theDSRIPprogramallowsformultipledatacollectionmethodstoensurebroadanddeepperformancemeasurement.ThissectiondescribeseachcalculationmethodologyasitappliestoDSRIPandtheanticipatedcollectionstepsbytheDSRIPhospitalandthehospital’sprojectpartners.Theseprovidersarecollectivelyreferredtoasthe“DSRIPNetwork.”NewJerseyLowIncomepopulationpatientswillbeassignedtoahospitalbasedonanattributionalgorithmwhichincludestheDSRIPNetworkasdescribedinSectionIV.

Asaquickreferencetolocatethedatasource,hospitalsmayrefertothePlanningProtocoladdendums,“Addendum1–Stage3MeasuresCatalogue”and“Addendum2–Stage4MeasuresCatalogue”undertheheading“NJDataSource”whereeachmeasureisnotedas“MMIS”(administrativeclaimcollectionmethodology)or“Chart/EHR”(medicalrecordcollectionmethodology).i. MMISMeasures:

ThestepsthatfollowdescribetheprocessthattheDepartmentwilltakeonthebehalfofhospitalsinordertocalculatemeasuresthatutilizeMMISdata.

Step1:TheDepartmentidentifiesthehospital‐specificattributedpatientpopulation.

ForeachMMIS‐calculatedmeasurethefirststepistocapturetheattributedpatientsforthehospitalforwhichthemeasureisbeingrun.TheattributionsectiondescribeshowtheNJLowIncomepopulationislinkedtoahospital.

Step2:Ofthoseattributedpatients,theDepartmentidentifiesthepatientsthatmeetthe

denominator(D)criteria.

Step3:Ofthosedenominatorpatients,theDepartmentidentifiesthepatientsthatmeetthenumerator(N)criteria.

Step4:TheDepartmentcomputestheresult.



PerformancemeasuresfromavarietyofcaresettingsarerepresentedintheDSRIPmeasureset.Examplesareprovidedbelow.ThesettingofcareforeachmeasureisindicatedontheDSRIPspecificationsheet.a. InpatientorEmergencyDepartmentSetting–referstoanyMMISmeasurethatonly

considerscarethatwasprovidedwithintheinpatientoremergencydepartmentsetting.Thiscouldbemonitoringasingleepisodeofcareorcomparingcareacrossinpatientoremergencydepartmentevents.1. DSRIP#1:30‐DayAll‐CauseReadmissionFollowingHeartFailure(HF)

Hospitalization2. DSRIP#6:AdultAsthmaAdmissionRate

b. OutpatientSetting–referstoanyMMISmeasurethatonlyconsiderscarethatwas

providedinanoutpatientsetting(e.g.hospital‐basedclinic,primarycareoffice,FederallyQualifiedHealthCenter(FQHC),behavioralhealthclinic).Thiscouldbemonitoringcareforasingledateofserviceorcomparingcareacrossmultipleoutpatientvisits.

1. DSRIP#5:AdolescentWell‐CareVisit2. DSRIP#88:Well‐ChildVisitsintheFirst15MonthsofLife

c. Multi‐Setting–referstoanyMMISmeasurethatconsiderscarereceivedinmultiple

settingsofcare.Thismaycomparecareacrossmultipleserviceevents,ortocapturediagnosisand/orprocedurecodestoreflectpatienttreatmenthistory.Comparingcareacrosssettingscandetermineiftheexpectedcoordinationorfollow‐upcaretookplacebetweensettings.

1. DSRIP#41:Follow‐upAfterHospitalizationforMentalIllness2. DSRIP#29:ComprehensiveDiabetesCare(CDC):HemoglobinA1C(HbA1C)

testing3. DSRIP#16:BreastCancerScreening

ii. Chart/EHRMeasures–InpatientorEmergencyDepartmentSetting:

Inthissection,thestepsthatfollowdescribetheprocessthatthehospitalwilltakeinordertosample,abstractandcalculatemeasuresthatutilizechart/EHRcollecteddata.Thefollowinggraphicrepresentsdatathatislimitedtothehospital’sdataonly.



Step1:ThehospitalreceivesthefinalretrospectiveattributedpatientpopulationlistfromtheDepartment.

Step2: ThehospitalrunsaqueryoftheirEHRsystemlimitedtosearchingforinformationaboutthe

attributedpatientpopulationonly.Thisqueryalwaysfirstincludeslookingforthemeasure‐specificdenominator(D)criteriaasoutlinedintheDSRIPspecificationsheetanddetailedbythemeasurestewardspecifications.Theresultisreferredtoastheinitialpatienttotal.

Step3:Thehospitalcomparestheinitialpatienttotaltothesamplingtablestodeterminethe

numberofpatientrecordsthatmustbeabstracted(refertoSectionIIIforsamplingtableinformation).

Step4:Thehospitalrunsastandardrandomsamplingquerytoselectthespecificpatient

recordsforabstraction.Step5:Thehospitalstaffreviewsthesampledpatientrecordstodetermineifthenumerator

(N)criteriahavebeenmet.

Step6:Thehospitalenterstheinitialpatienttotal,numeratoranddenominatorvaluesintotheNJDSRIPStandardReportingWorkbook.Formulaswithintheworkbookwillautomaticallycalculatetheresult.TheNJDSRIPStandardReportingWorkbookisaccessibleviatheNewJerseyDSRIPwebportalloginat:https://dsrip.nj.gov/.

Examplesofinpatientoremergencydepartmentsettingchart/EHRmeasuresthatwouldfollowthesestepsareprovided.a. InpatientorEmergencyDepartmentSetting–thisreferstoanychart/EHRmeasurethat

onlyconsiderscarethatwasprovidedwithintheinpatientsetting.Thiscouldbeasingleepisodeofcareorcomparingthedeliveryofcareacrossinpatientoremergencydepartmentevents.

1. DSRIP#6:AdultAsthmaAdmissionRate2. DSRIP#73:Post‐DischargeAppointmentforHeartFailurePatients



iii. Chart/EHRMeasure–OutpatientSettingOnly–SingleReportingProvider:

Inthissection,thestepsthatfollowdescribetheprocessthatasingleoutpatientproviderwilltakeinordertosample,abstractandreportmeasurestothehospital,whichwillthenbereportedtotheDepartment.Theoutpatientprovidermaybeahospital‐basedclinicoranoutpatientcommunity‐basedprovider.Thefollowinggraphicrepresentsdatathatislimitedtotheclinic’sdataonly.

Step1:TheoutpatientproviderreceivesthefinalretrospectiveattributedpatientpopulationlistfromtheDepartment.

Step2: TheoutpatientproviderrunsaqueryoftheirEHRsystemlimitedtosearchingfor

informationabouttheattributedpatientpopulationonly.Thisqueryalwaysfirstincludeslookingforthemeasure‐specificdenominator(D)criteriaasoutlinedintheDSRIPspecificationsheetanddetailedbythemeasurestewardspecifications.Theresultisreferredtoastheinitialpatienttotal.

Step3:Theoutpatientprovidercomparestheinitialpatienttotaltothesamplingtablesto

determinethenumberofpatientrecordsthatmustbeabstracted(refertoSectionIIIforsamplingtableinformation).

Step4:Theoutpatientproviderrunsastandardrandomsamplingquerytoselectthespecific

patientrecordsforabstraction.Step5:Theoutpatientproviderstaffreviewsthesampledpatientrecordstodetermineifthe

numerator(N)criteriahavebeenmet.

Step6:Theoutpatientprovidersubmitstheinitialpatienttotal,numeratoranddenominator

valuestothehospitalalongwithpatient‐leveldata.



Step7:Thehospitalenterstheinitialpatienttotal,numeratoranddenominatorvaluesinto

theNJDSRIPStandardReportingWorkbook.Formulaswithintheworkbookwillautomaticallycalculatetheresult.TheNJDSRIPStandardReportingWorkbookisaccessibleviatheNewJerseyDSRIPwebportalloginat:https://dsrip.nj.gov/.

Examplesofoutpatientsettingonly,chart/EHRmeasuresthatwouldfollowthesestepsareprovided.a. OutpatientSetting–referstoanychart/EHRmeasurethatonlyconsiderscarethatwas

providedinanoutpatientsetting.Thiscouldbeasingleserviceeventoracomparisonacrossvisits.

1. DSRIP#15:BipolarDisorderandMajorDepression:Appraisalforalcoholorchemicalsubstanceuse

2. DSRIP#65:Percentofpatientsevaluatedforenvironmentaltriggersotherthanenvironmentaltobaccosmoke(dustmites,cats,dogs,molds/fungi,cockroaches)eitherbyhistoryofexposureand/orallergytesting

3. DSRIP#79:ScreeningforClinicalDepressionandFollow‐upPlan



iv. Chart/EHRMeasure–OutpatientSetting–MultipleReportingProviders:

Ifthehospitalispartneringwithmultipleoutpatientreportingproviders,(e.g.multiplehospital‐basedclinics,multiplecommunity‐basedreportingpartners,ahospital‐basedclinicandanoutpatientcommunity‐basedreportingpartner,acommunity‐basedreportingpartnerandanenhancedreportingpartner)regardlessofthecombinationthatcouldcollecttherequiredperformancedata,thefollowingsampling,abstractionandreportingstepsapply.Thefollowinggraphicrepresentsdatathatislimitedtotheclinics’dataonly.ProviderAwillonlycollectinformationavailabletoProviderA.ProviderBwillonlycollectinformationavailabletoProviderB.

Step1:TheoutpatientprovidersreceivethefinalretrospectiveattributedpatientpopulationlistfromtheDepartment.

Step2:EachoutpatientproviderrunsaqueryoftheirEHRsystemlimitedtosearchingfor

informationabouttheattributedpatientpopulationonly.Thisqueryalwaysfirstincludeslookingforthemeasure‐specificdenominator(D)criteriaasoutlinedintheDSRIPspecificationsheetanddetailedbythemeasurestewardspecifications.Theresultisreferredtoastheinitialpatienttotal.

Step3:Eachoutpatientprovidercomparestheirinitialpatienttotaltothesamplingtablesto

determinethenumberofpatientrecordsthatmustbeabstracted(refertoSectionIIIforsamplingtableinformation).

Step4:Eachoutpatientproviderrunsastandardrandomsamplingquerytoselectthespecific

patientrecordsforabstraction.Step5:Eachoutpatientproviderstaffreviewsthesampledpatientrecordstodetermineifthe

numerator(N)criteriahavebeenmet.Step6:Eachoutpatientprovidersubmitstheinitialpatienttotal,numeratoranddenominator

valuestothehospitalalongwithpatient‐leveldata.



Step7:Thehospitalcomparesthedatareceivedfromeachoutpatientprovidertodetermine

ifthereisanypatientduplicationbetweenproviders.Ifduplicationofpatientsexists,thehospitalreplacestheduplicatewithanoversamplerecord.

Step8: Thehospitalentersthefinalinitialpatienttotal,numeratoranddenominatorvalues

foreachproviderintotheNJDSRIPStandardReportingWorkbook.Theworkbookwillautomaticallycalculatetheapplicableweightingfactorandfinaladjustedaggregatedperformanceresultapplicableforthehospital’sDSRIPNetwork.

Toobtainahospital‐levelrateforameasurethatisdevelopedfromtheratesofmultiplereportingentities,suchasacrossmultiplehealthclinicsorphysicianoffices,aweightedaverageoftheindividualrateswillbecalculated.Howmuchanyonereportingproviderwillcontributetotheweightedaverageisbasedonthesizeoftheprovider’seligiblepopulationforthemeasure.Thismeansthatproviderswithlargereligiblepopulationswillcontributemoretowardtheratethanthosewithsmallereligiblepopulations.

ExampleofReportingwithMultipleOutpatientProviders:

HospitalX‐“NewJerseyStateHospital”isconductingProject5–ElectronicSelf‐AssessmentDecisionSupportToolandpartneringwithtwobehavioralhealthclinics(ClinicA‐“NewJerseyStateCommunity‐basedClinic”andClinicB–“NewJerseyStateHospital‐basedClinic”)toimplementtherequiredinterventions.FromthePlanningProtocol,Addendum1–Stage3MeasuresCatalogue,“NewJerseyStateHospital”identifiesthatforProject5therearefourStage3measuresrequiredtobereportedbytheiroutpatientprojectpartner:5.2,5.3,5.5,and5.9.

Specifically,formeasure5.2,“NewJerseyStateHospital”identifiesthismeasureasDSRIP#15–BipolarDisorderandMajorDepression:Appraisalforalcoholorchemicalsubstanceuse.Themeasureidentifiesthepercentageofpatientswithdepressionorbipolardisorderwithevidenceofaninitialassessmentthatincludesanappraisalforalcoholorchemicalsubstanceuseandmustbecollectedbyabehavioralhealthprovider.“NewJerseyStateHospital”recognizesthatClinicA‐“NewJerseyStateCommunity‐basedClinic”andClinicB–“NewJerseyStateHospital‐basedClinic”willberequiredtofollowsteps1through6describedforoutpatientmeasureswithmultiplepartners.“NewJerseyStateHospital”willcompletesteps7and8.

ClinicA‐“NewJerseyStateCommunity‐basedClinic”receivestheattributedpatientpopulationlistandrunsaquerytoidentifypatientsthatmeetthedenominatorcriteria(age,diagnosisandtreatmenthistoryasdescribedinthemeasurespecificationcriteriaforDSRIPmeasure#15).ClinicA’squeryreturns500patientsthatmeetallofthedenominatorcriteria.Thisistheirinitialpatienttotal.



ClinicB–“NewJerseyStateHospital‐basedClinic”followsthesameproceduresandtheirqueryreturns1500patientswhichistheirinitialpatienttotal.Althoughthetotalforbothclinicsis2000,ClinicBhasseventy‐five(75)percentoftheeligiblepatientsandClinicA,onlytwenty‐five(25)percent.Eachclinic’smeasureresultwillbemultipliedbytheirassociatedpopulationproportionforaweightedresult.Becausethemeasurerequiresanannualmeasurementperiod,ClinicAcomparestheirresultstotheannualsamplingtableprovidedinthesamplingsection.ClinicAdeterminesthattheymustsampletwenty‐five(25)percentoftheirinitialtotalpopulation,foratotalsampleof125patientcharts.ClinicBcompletesthesamestepsanddeterminesthattheymustsample250charts.StafffromClinicAreviewseachofthe125chartstodetermineiftheassessmentforalcoholorothersubstanceusewascompletedwithin42daysoftheinitiationoftreatmentasrequiredtomeetthenumeratorcriteria.38chartswerefoundtobenumeratorcompliantwhichresultsinarateof30percent(.304).Thispercentismultipliedbytheclinic’sweightedfactorforanadjustedrateof.076.Ofthe250chartreviewscompletedbyClinicB,63arefoundtomeetnumeratorcriteria.Theresultis25percent(.252).Theresultismultipliedbytheclinic’sweightedfactorforanadjustedrateof.189.Theadjustedclinicratesaresummedforanoverallhospitalrateof.265.Thisisroundedtothehundredthplaceforafinalresultof.265or26.50%.

BHClinicA BHClinicB TotalCalculatedRate=

Queryidentifies=500patientsQueryidentifies=1500patients 2000NJLowIncomepatients

Samplerequired=25%=125 Samplerequired=250 375samplesN=38 N=63 N+N=38+63=101D=125 D=250 D+D=125+250=375%=30%(38/125=.304) %=25% (63/250=.252)

ClinicAdjustedRate=(CalculatedResult)(WeightedFactor)HospitalAdjustedTotalRate

WeightedFactorforClinicA‐500/2000=25%

(.304)(.25)=.076.076+.189=.265=26.50%

WeightedFactorforClinicB‐1500/2000=75%

(.252)(.75)=.189

ThisexamplecanalsobefoundintheStandardReportingWorkbook.



E. DataSpecificationConditions

i. MMISRepresentedDataThedatathatismadeavailableforperformancemeasurementincludespaidMedicaidandCHIPclaims,bothfee‐for‐serviceandmanagedcareencounterclaimsandCharityCareclaims.

ii. PerformanceMeasureCalculationandReportingTimePeriodsHospitalsshouldadheretothemeasurementperiodsidentifiedinthespecificationsforeachmeasure.Thereareseveraltimeperiodsthataffectperformancemeasurestobeawareofandaredefinedbelow.

a. Look‐backPeriod–Somemeasuresareindexedtoaspecificdateorevent,suchasahospitaldischarge,wherethemeasurerequiresthatacertaindiagnosisbepresentwithinadefinedpriorperiodtotheindexeventforthepatienttobeincludedinthepopulation.Thispriorperiodisreferredtoasthelook‐backperiod.

b. ExperiencePeriod–Theexperienceperiod,otherwisereferredtoasthemeasurementperiod,indicatesthespecificdurationoftimeinwhichthedatesofservicemusttakeplaceinordertobeconsideredforthemeasure.

c. ReportingPeriod–Thetimeperiodforwhichthemeasuremustbereported.NewJerseyDSRIPmeasuresmustbereportedannuallyorsemi‐annually.Eachmeasurespecificationsheetindicatesthereportingperiod,aswellaswhenthereportisduetobereportedby,oronthebehalfof,thehospital.

d. BaselinePeriod–Thetimeperiodforwhichthefirstmeasurementwillbecomputed.Futureperformancewillthenbecomparedagainstthebaselineperiod.Eachmeasurespecificationsheetindicatesthebaselineperiod.ForMMISmeasures,20162datawillbeutilizedtosetthemeasures’NewJerseyimprovementtargetgoal(ITG).Thebaselineperiodforthemajorityofchart/EHRmeasureswillutilize20164abstracteddataunlessotherwisenoted.

iii. EligiblePopulation

TheeligiblepopulationisreferredtocollectivelyastheNewJerseyLowIncomepopulation.ThisincludesMedicaid,CHIPandCharityCarepatients.Thisincludesfeeforservice,managedcareanddualcoverage(i.e.MedicareandMedicaid)populations.Forallmeasures,theeligiblepopulationisassignedtoahospitalbasedontheattributionmodeldiscussedinSectionIIandthedenominatorpopulationisidentifiedasasub‐setoftheseassignedpatientsbasedonmeetingeachmeasure’sspecificdenominatorcriteria.

iv. AgeCriteriaTheagecriterionisspecifictoeachmeasure.Theagecanbecalculatedasofthelastdayofthemeasurementperiodorthedateoftheservice.



a. AgeStratifications–Measureresultscanbecategorizedintopopulationagerangestodrilldownonclinicalcareoutcomesforvariousagegroups.Themeasuresteward’sagestratificationswerefollowedunlesstheagerangeswereconsideredtobetoonarrowortoobroadtoeffectivelycaptureDSRIPpopulationhealthresults.Iftheagestratificationwasmodified,theagestratificationoftheMedicaidAdultorChildCorewasusedwhenappropriate.Forinstance,ifameasurewasoriginallycapturedfortheMedicarepopulation(65yearsandolder),itwasadjustedto18through64and65yearsandolder.Thisisdocumentedinthemeasurespecificationsheet.

b. PayforPerformance(P4P)–Whenthereareagestratifications,theagestratificationthatappliestoP4Pincentivepaymentswillbethe“Total”agegroupunlessotherwiseindicated.

v. ContinuousEligibilityThisreferstothedurationoftimeapatientmustbeeligibleforbenefitstobeincludedinthemeasuredenominator.Thespecificationsprovidethecontinuousenrollmentrequirement(ifrelevant),foreachmeasure.PleasenotethatalthoughCharityCarepatientsdonothaveanestablishedbenefitperiod,CharityCarepatientshavebeengivenaproxytwelvemonthsofcoverageifthereisasingledateofservicewithinayear.

vi. MemberMonthsMembermonthsareamember’scontributiontothetotalyearlymembership.Membermonthswillbecalculatedbasedoncountingmembersenrolledasofthelastdayofthemonth.Monthsinwhichmemberswereenrolledretrospectivelywillbeincludedinthecountfortotalmembermonths.

vii. Smallnumbersa. MMIS‐Regardlessofthevolumeofpatientsidentifiedinthedenominator,theresults

willbereportedonbehalfofthehospital.b. Chart/EHRmeasures‐Ifameasurehasadenominatorthatislessthanallowedbythe

applicablesamplingtable,theentirepopulationistobereportedandsamplingwillnotapply.

viii. Riskadjustment

Each30‐dayreadmissionmeasurerequiresriskadjustment.Thesemeasuresestimatethehospital‐level30‐dayall‐causerisk‐standardizedreadmissionrate(RSRR)byusingahierarchicallogisticregressionmodel(aformofhierarchicalgeneralizedlinearmodeling[HGLM]).Themodelseekstoadjustforcasedifferencesbasedontheclinicalstatusoftheeligiblepatients.Tocompletethisregressionmodel,theYaleGroupdevelopedanddesignedaSASprogramtobeusedwithpre‐processedCMSadministrativedatafortheanalysisoftheMedicarepopulation.However,thesemeasurescurrentlydonothaveariskadjustorfortheMedicaidpopulation.



InordertousetheSASprogramtocalculatereadmissionmeasuresforNewJersey’sLowIncomepopulation,therelevantMedicaidfieldswereidentified.Medicaredataelementswerethencross‐walkedtoappropriateMedicaidcounterparts.Theriskapproachadjustsforkeyvariablesthatareclinicallyrelevantandhavestrongrelationshipswiththeoutcome(e.g.,age,gender,comorbiddiseasesandindicatorsoffrailty).Theriskadjustmentprocessisdiscussedinmoredetailundereachapplicablemeasureandoffersguidancetorelateddetailedmeasurestewardmaterials.

ix. Codesa. CodeSpecificity–AppendixAhasbeenupdatedtoincludeValueSetswiththehighest

levelspecificitiyandshouldbeutilizedwhendeterminingmeasureresults.ToreducethesizeoftheDatabook,thecodetableswithinthemeasurespecificationshavebeenchangedtocoderanges.

b. CodeTableVersions–Nationalcodesprovidedhavebeenupdatedtothelatestversionsavailable.ICD‐10codeshavebeenaddedalongsideICD‐9codeswhenprovidedbythemeasuresteward.Formeasuresthathavenotbeenupdated,ICD‐10codesweremapped(forwardonlyfromICD9to10)usingtheAHRQMapIT2015tool(http://www.qualityindicators.ahrq.gov/resources/Toolkits.aspx).Therefore,measurestewardsthathaveutilizedolderversionswillreflectupdatedcodes.

c. Adjustments–TheMedicarediagnosisrelatedgroups(MS‐DRGs)areusedbytheCentersforMedicare&MedicaidServices(CMS)forhospitalpaymentforMedicarebeneficiariesandareutilizedwithinthenationalmeasurespecification.InordertomorecloselyaligntotheDSRIPprogram,thespecificationsinclusiveoftheMS‐DRGshavebeensubstitutedwithNewJerseyAllPatientDiagnosisRelatedGroups(AP‐DRG)forinpatientclaimsdatameasures.Thecrosswalkprocessdoesnotaccountforpaymentofsuchgroupings,buthavebeenutilizedtorepresentthesteward’sclinicalspecificationsascloselyaspossible.

d. CodeUse–PleasenotethatthecodesprovidedintheDatabookareforqualityanalysispurposesonly.Thesecodesarepublishedbytherespectivenationalmeasurestewardstodeterminemeasureresultsbutmaynotreflectthecareorbillingpracticesofyourorganization.

x. ClaimTypes–

Forbothpaperandelectronicclaimformats,thedeterminationofwhatconstitutesaclaimisdefinedbyNationalBillingCommittees.GeneralizedguidelinesarerequiredoneachclaimtoidentifythetypeofserviceorTypeofBillrepresentedbythesubmitteddata.Certainbilltypesaredesignatedbyrequireddatacomponentswhichareutilizedfortheadjudicationofthesubmittedclaim,whileotherdatacomponentsmaybeprovidedasameansofadditionalinformationonly.ThedataelementsrequiredbytheNewJerseyMedicaidclaimprocessingwereidentifiedthroughtheuseofbillingsupplementsandtrainingdocumentslocatedwithintheNJMMISwebsite.



F. StandardReportingWorkbookSubmissionProcedures

Thestandardexcelreportingworkbookpresentedwiththisdatabookisexpectedtobecompletedbythehospitalbyenteringtheinitialpatienttotal,numeratoranddenominatorvaluesfollowingthechart/EHRprocesspreviouslydescribed.ThecompletedexcelreportistobesubmittedviatheNewJerseyDSRIPwebportalat:https://dsrip.nj.gov/,thefiletransferprotocol(FTP)process,orotherapprovedmethod,administeredbytheDOH’sDSRIPvendorbasedonthereportingdeadlinesindicatedbythemeasurespecification.QuestionsregardingthesubmissionprocessmaybeforwardedtoNJDSRIP@mslc.com.

G. MMISMeasureAcknowledgementProcess

TheMMISdatameasureresultscomputedonbehalfofthehospitalswillbemadeavailabletohospitalsforviewingbasedonthereportingperiodsindicatedinthemeasurespecification.Thehospitalswillbeprovidedtheopportunitytoviewandexportthefinalnumerator,denominatorandcomputedresultsthroughtheDSRIPwebpage.HospitalswillbeexpectedtoprovideacknowledgementtotheDepartmentofHealth(“Department”)inaccordancewiththeDSRIPMMISmeasurestimelinesandbyfollowingthestepsbelow:OntheDSRIPwebsite,thehospitalwillbeabletologontoasecureportalwithuserprofileinformation.

1. EachparticipatingDSRIPhospitalwillselecttheapplicabletabfromtheDSRIPwebsitehomepage.

2. Theselectionwillprovideauserlog‐inboxthatwillallowtheuser,basedontheuser'sprofile,tologdirectlyontotheAcknowledgementpagefortheindividualhospital.

3. FromtheAcknowledgementpage,theuserwillbeprovidedalistofthosemeasuresthatarespecifictotheirprojectaswellasuniversalmeasuresthatarecomputedusingtheMMISdatasourceonly.

4. Theuserpagewillcontainthenumerator,denominatorandthecalculatedresultforeachmeasurement.Thewebpagewillcontainanoptiontoexporttheinformationfoundontheacknowledgmentpagetotheuser'sfilesbyselectingtheDownloadbuttonlocatedonthebottomleftofthepage.

5. TheuserwillthenselecttheAcknowledgementbuttonlocatedonthebottomrightofthepagetoprovideassurancetotheDepartmentthattheinformationhasbeenreviewed.ByselectingtheAcknowledgementbutton,theinformationwillbeelectronicallyforwardedtotheDepartmentensuringthehospitalhashadtheopportunitytoviewtheircomputedresults.



II. AttributionMethodology–

A. Purpose

ThefundamentalobjectiveoftheattributionmodelistoidentifytheNewJerseyLowIncomepatientpopulationandassignpatientstoNewJerseyhospitalstomonitortheeffectsoftheDSRIPprogramonpopulationhealth.Theintentistodothisinawaythatbestreflectsthepatient‐hospitalrelationshipandthepatient’shistoricalserviceutilization.Inparticular,thisassignmentwillmonitoradefinedpopulationandtheinfluenceofthehospital’sprojectperformanceonpatients’utilizationofservicesandhealthcareoutcomes.Thiseffectisquantifiedandthenmonitoredbymeansofproject‐specific(Stage3)anduniversal(Stage4)performancemeasuresets.

B. OverviewofAttribution

FollowingtherequirementsofSectionVII.A.ofthePlanningProtocol,performancemeasurementforbothStage3andStage4metricswillmeasureimprovementbasedonamodeltolinktheNewJerseyLowIncomepatientpopulationtoDSRIPhospitalsbasedonafederalattributionmodel(e.g.PioneerAccountableCareOrganization(ACO)orMedicareSharedSavingsProgram(MSSP))orastatemodel(e.g.stateACOorMedicaidManagedCareOrganization(MCO)).

Generally,theseattributionmodelsseektodeterminewhichprovider,orsetsofproviders,shouldbeassignedresponsibilityforapatient’scare.Thegoalofattributionistocaptureascloselyaspossibletherelationshipbetweenpatientsandproviders.Inordertodothis,someimportantproceduralchoicesareconsideredandthesearediscussedbrieflybelow.TheNewJerseyDSRIPmodelalignsattributionfeaturestothoseprogramsmentionedabove,butwhennecessary,makesadjustmentstomorepreciselymeettheobjectivesofthisuniqueprogram.

i. Prospectivevs.Retrospective

Prospectiveattributionuseshistoricalclaimstolinkpatientswithproviderspriortothestartofaspecifiedmeasurement(experience)period.Inthismethod,providersknowinadvancethosepatientsforwhomtheyareresponsible.Ifthemodelseekstoemphasizealongitudinalpatient‐providerrelationship,thenmultipleyearsofdataareused.Retrospectiveattributionalsoassignspatientstoprovidersusinghistoricalclaims.However,inaretrospectivemodel,attributionoccursattheendofthemeasurementperiod.Thisapproachattemptstoincludeonlythosepatientswhohaveactuallyreceivedcarefromtheproviderstowhomtheyarelinkedandforwhichperformancemeasurementisbasedon.

FortheNewJerseyDSRIPprogram,hospitalswillbeabletoreceiveapreliminaryprospectiveattributionlisttosupportidentification,outreachandengagementofpatients



inahospitalproject.Forcomputationofthemeasures,afinalretrospectiveattributionwillapply.

ii. ProvidersHistorically,attributionmodelshaveassignedpatientstoprimarycarephysicians(PCP),physiciangroups,oraccountablecareorganizations(ACOs)comprisedofPCP’sandselectspecialists.ForNewJerseyDSRIP,thehospitalsetting(i.e.thehospital‐basedclinicandemergencydepartment)istheemphasizedproviderinordertoefficientlymatchthepatienttotheresponsibleentityleadingtheDSRIPproject(i.e.theparticipatinghospital).However,itwillalsoconsiderservicesreceivedatsettingsotherthanthehospital.Itwillalsoincludethecarereceivedatthehospital’scommunity‐basedreportingpartner.

iii. TypesofServices

Physician‐basedattributionmodelstypicallyhaveusedallphysicianclaimsorEvaluationandManagement(E&M)physicianclaimstodetecthistoricaldatautilizationpatternstotiepatientstoproviders.ForNewJerseyDSRIP,E&Mclaims(acrossallplacesofservice)areusedtodeterminepatients’historicalpatternsofcare.ThisincludesthoseE&MvisitsprovidedinthehospitalED.TheinclusionofEDclaimswillhelpidentifythosepatientswhoneedtodevelopandenhanceprimarycareutilization.ImproperutilizationoftheEDcanbeanimportantsignalofthosepatientswhohavethegreatestneedforchroniccarecoordination.EffectivemanagementofcareforthesepatientswilldemonstratethedeliverysystemreformimprovementsanticipatedfortheDSRIPprogram.

iv. Singlevs.Multiple

Anotherkeyelementofpatientattributioniswhetherthemodelassignsapatientonlytoasingleproviderortomultipleproviders.Multipleattributionsuggeststhatnosingularprovidercanbeassignedsoleresponsibilityforapatient’scarebecausenooneproviderhascompletecontroloverapatient’shealthcaredecisions.However,thisapproachmakesaccountabilityforperformancemeasurementproblematic.IntheNewJerseyDSRIPmodel,singleattributionisused.Apatientisassignedasinglehospital.

v. Patientvs.Episode

Anadditionalaspectofattributionisthespectrumofhealthservicesincluded.Onemethodbasesattributiontoaprovideronanepisodeofclinicalservices.Anepisodeofcarebeginsfromthediagnosisofsymptomsuntiltreatmentiscomplete.Theproviderisnotheldresponsibleforapatient’scarebeyondthesingleepisodeofcare.Themorecommonapproachistoconsiderthefullrangeofservicesforapatientoveraspecifiedtimeperiod,



e.g.,ameasurementyear.Inthepatient‐basedapproach,aproviderisassignedapatientfortheentiretimeperiod.IntheNewJerseyDSRIPmodel,patientattributionisused.

vi. Pluralityvs.MajorityAttributionmodelsmustdecidewhetherassignmentisbasedonapatientreceivingamajorityorpluralityofservicesfromaprovider.Amajorityisdefinedasmorethan50%ofthepatient’shealthcareservices(eithervisitsorcosts).Apluralityisdefinedmoresimplyasthelargestproportionofservices(eithervisitsorcosts).Aplurality‐basedmethodologyistypicallyadoptedinattributionmodelsbecauseitallowsforagreaterassignmentofpatients.IntheNewJerseyDSRIPmodel,assignmentisbasedonaplurality(i.e.simplemajority)ofvisits.

vii. Visitsvs.Cost

Theattributionmethodcanbebasedonvisitsorsomemeasureofproviderpayments.Mostoften,apluralityofservicesisbasedoneitheracountofvisitsorasumofcosts.Modelsusingthecostapproachtypicallyuseallowedchargeswhicharenotdistortedbythird‐partypayments.Themethodofusingapluralityofallowedchargesemphasizesthemorecomplexservicesascapturedbycost,whereascountingvisitsweightsallservicesequally.IntheNewJerseyDSRIPmodel,E&Mvisitsareused.Astheadministrativeclaimsincludemanagedcaredatathatwaspaidbyacontractedhealthplanandthensubmittedtothestatefordatacapture,theuseofvisitsoverpaymentsmaximizesvalidatedadjudicationprocedures.

Thetimeperiodofthevisitsarealsotakenintoaccount.Morerecentservicehistoryreceivesanincreasedweightingvaluewhichemphasizesapatient’scurrentutilizationandprovideraffiliationovertheirhistoricalutilization.TheweightingfactorappliedfortheNewJerseyDSRIPmodelis30/70.

viii. MinimumPatientVolume

IntheNewJerseyDSRIPmodel,thereisnominimumpatientvolumeasthereareinthefederalattributionmodels.



C. NewJerseyDSRIPAttributionProcessAllofthefeaturesmentionedabovearecomponentsoftheattributiondesign.Specifically,fortheinitialassignment,theNewJerseymodeltakesintoaccountallNewJerseyLowIncomepatientswithserviceutilizationduringtheyears2012and2013.Themostrecentyearreceivesaweightedfactorof70percent,whiletheearlieryearreceivesa30percentweight.Aspreviouslydiscussed,theservicehistoryofeachpatientisbasedonevaluationandmanagement(E&M)billingcodes.ThesameE&McodesthatareutilizedintheMedicaremodelsareused,plustheadditionofselectemergencydepartment(ED)codes.TheseareprovidedinAppendixB‐ProgrammingAssumptions.OncetheE&Mcodesareidentifiedforeachpatient,thevisitcountsaremultipliedbytheapplicableweightingfactor.Note:InDY3andDY4,attributionwascalculatedonceperyear.StartinginDY5,attributionwillbecalculatedtwiceayearforsemi‐annualmeasures.Eachpatient’sE&Mvisitsarearrangedinahierarchicalgrouping:

Category1‐Visitstohospital‐basedclinicsaregroupedtogether–Ahospital‐basedclinicisdefinedasaclinicthatisallowedtobillunderthehospital’sprovideridentifier,isincludedonthehospital’scostreport,andbillsontheUniversalBill(UB)claimformwithspecifiedrevenuecodes(510‐519).RefertoAppendixBforfurtherdetail.

Category2‐Visitstoemergencydepartmentsaregroupedtogether

Category3‐Visitstocommunity‐basedreportingpartnersaregroupedtogether–Acommunity‐basedreportingpartnerisanyoutpatientgroup/facility/clinicaffiliatedtothehospitalthathasanagreementwiththehospitaltoimprovepopulationhealththroughimprovedcarecoordination,aswellasonewhowillcollectandreportonStage3DSRIPmeasures.Acommunity‐basedreportingpartnercanbeidentifiedasaclinicthatdoesnotbillasahospital‐basedclinic.ThiscouldbeaFederallyQualifiedHealthCenter(FQHC),aphysicianpracticegroup,orbehavioralhealthfacility.Acommunity‐basedreportingpartnerwillbeincludedinthedevelopmentoftheImprovementTargetGoals(ITGs).Enhancedreportingpartnersareanothertypeofcommunity‐basedreportingpartner.EnhancedreportingpartnersarethosewhohavetodevelopreportinginfrastructureandwillnotbeincludedinthesettingoftheITGs.

Category4‐Visitstoallothernon‐participatingprovidersaregroupedtogetherToactasfurtherevidenceofanestablishedrelationshipwithaprovider,aminimumthresholdoftenpercent(10%)ofutilizationpercategoryisincludedintheattributionapproach.IfapatienthasreceivedtenpercentoftheirtotalvisitswithinCategory1,thepatientwillbe



assignedbasedonthosevisits.Ifthethresholdisnotmet,themodelcascadesthroughthehierarchytothecategorywheretheminimumthresholdismet.Ifapatienthasvisitswithmultipleproviderswithinacategory,thepatientisthenattributedtotheproviderwiththeplurality(i.e.simplemajority)ofvisitswithinthecategory.Thestepsfortheattributionapproachareasfollows:Step1: ReviewCategory1Step2: DetermineifCategory1weightedvisittotalmeets10%thresholdStep3: Ifthethresholdismet,identifytheproviderwiththeplurality(i.e.simple

majority)ofvisitswithinCategory1Step4: Ifthethresholdisnotmet,proceedtonextcategoryandrepeatsteps.

PatientSmith‐AttributionExample:

Provider Visits(unweighted) WeightedVisits AttributionCategoryCategory1:Hospital‐basedClinicsHospital‐basedClinicA 4 1.2 Hospital‐basedClinic

CategoryTotal 4 1.2Category% 5.19% 2.57% Hospital‐basedClinic

Category2:EmergencyDepartmentsHospitalEDA 31 19.7 EDHospitalEDB 31 19.3 EDHospitalEDC 8 4.4 EDCategoryTotal 70 43.4Category% 90.91% 92.93% ED

Category3:Community‐basedReportingPartnersCommunity‐based

Partner0 0 ProjectPartner

CategoryTotal 0 0Category% 0.00% 0.00% ProjectPartner

Category4:Allotherproviders;NoattributionFQHC 2 1.4 Non‐Hospital

Physician 1 0.7 Non‐HospitalCategoryTotal 3 2.1



Category% 3.90% 4.50% Non‐HospitalOverallTotal 77 46.7

PatientSmithhashad77totalvisitsduringtheyears2012and2013.Aftertakingintoaccounttheapplicableweightingfactorbasedontheyearoftheservice,thetotalweightedvisitsis46.7.WithinCategory1,theservicevisittotaldoesnotmeettherequired10%threshold.WithinCategory2,thethresholdismetandtherearethreehospitalswherethepatienthasreceivedcare.AlthoughthepatientsawbothHospitalAandHospitalBatotalof31timesoverthecourseofthetwoyearperiod,HospitalAhasaslightlymoreestablishedrelationshipwiththepatientasidentifiedbytheweightedvisittotal.ThepatientisattributedtoHospitalA.



III. SamplingMethodology

A. SampleSizeforHospitalMeasures

Hospitalsthatchoosetosampleinordertocollectandreportchart/EHRmeasureresultshavetheoptionofsamplingsemi‐annuallyorsamplingonanannualbasisdependingupontheexperienceperiodofthemeasure.Thesamplesizerequirementsforeachoftheseoptionsaredescribedbelow.Hospitalsneedtoroundtothenexthighestwholenumberwhendeterminingtheirrequiredsamplesize.Seebelowforroundingexamples.HospitalsselectingsamplecasesformeasuresthatarenotstratifiedmustensurethatitsinitialtotalpatientpopulationandsamplesizemeettheconditionsstatedinTable1.Oncethepopulationsizehasbeencalculated,arepresentativerandomsamplecanbechosenusingTable1forannualsamplesorTable2forsemi‐annualsamples.Note:Hospitalsarenotrequiredtosampletheirdata.Ifsamplingoffersminimalbenefit(i.e.,ahospitalhas80casesforthequarterandmustselectasampleof76cases)thehospitalmaychoosetouseallcases.SampleTable1:AnnualSampleSizeExample

AnnualDenominatorInitialPatientTotal

“N”

MinimumRequiredSampleSize

“n”>1001 250

401‐1000 25%oftheDenominatorPatientPopulation151‐400 10076‐150 7546‐75 451‐45 Nosampling;100%oftheDenominatorPatient

Populationisrequiredi. AnnualExamples

1. Ahospital’sHypertensiveInitialPatientTotalis43patientsduringtheyear.Usingtheabovetable,nosamplingisallowed–100percent(%)ofthepopulationisrequired.

2. Ahospital’sHeartFailureInitialPatientTotalis300patientsduringtheyear.Usingtheabovetable,therequiredsamplesizeisseentobeaminimumof100patients.

3. Ahospital’sDiabeticInitialPatientTotalis450patientsduringtheyear.Usingtheabovetable,therequiredsamplesizeisseentobe25percent(%)ofthepopulation,or113casesfortheyear.



SampleTable2:Semi‐AnnualSampleSizeDenominatorSemi‐Annual

InitialPatientTotal“N”

MinimumRequiredSampleSize

“n”>501 150

301‐500 25%oftheDenominatorPatientPopulation76‐300 7546‐75 451‐45 Nosampling;100%oftheDenominatorPatient

Populationisrequired

i. Semi‐AnnualExamples

1. Ahospital’sPretermNewbornInitialPatientTotalis25patientsduringthesixmonthperformanceperiod.Usingtheabovetable,nosamplingisallowed–100percent(%)ofthepopulationisrequired.

2. Ahospital’sAsthmaInitialPatientTotalis130patientsduringthesixmonthperformanceperiod.Usingtheabovetable,therequiredsamplesizeisseentobeaminimumof75patientsforthismonth.

3. Ahospital’sNullipariousSingletonDeliveryInitialPatientTotalis301patientsduringthesemi‐annualperiod.Usingtheabovetable,therequiredsamplesizeisseentobe25percent(%)ofthepopulation,or76casesforthemonth(twentypercentof301equals75.25roundedtothenextwholenumberequals76).

ii. Steward‐specificSamplingProcedures

Forhospitalsselectingsamplecasesforstratifiedmeasuresetsormeasuresetswithsub‐populations(CACandVTE),amodifiedsamplingprocedureisrequired.Hospitalsselectingsamplecasesforthesesetsmustensurethateachindividualstratum’spopulation/sub‐populationandsamplesizemeetstheconditionsstatedinthemeasuresteward’sSampleSizeRequirements.(SeeVTEandCACsamplerequirementsfromtheJointCommissionasindicatedwithintheDSRIPmeasurespecification.)



IV. SpecificationSheetDescriptionandDefinitions

Eachmeasurespecificationsheetisdividedintofoursections.

Theopeningsectionprovideshighlevelreferencesincludingthemeasuretitle,DSRIPnumber,measuredescription,datasource,NationalQualityForum(NQF)number,themeasurestewardandmeasurestewardversion.

Thesecondsectionislabeledthe“MeasureCalculationDescription.”Thissectionprovidestheprimaryinformationrequiredtocalculatethemeasureincludingthenumerator,denominator,resultinformationandanyqualificationstothecriteriathatprovideadditionalinformation.

Thethirdsectionislabeled“MeasureCollectionDescription”andprovidesfieldsrelatedtothecollectionprocessforexamplethesettingofcare,reportingparametersandwhethersampling,continuouseligibilityorriskadjustmentappliestothemeasure.Thissectionwillalsoincludetheimprovementtargetgoaldetails.

Thefinalsectionislabeled“DSRIPIncentiveImpact”andidentifiestheStage3projectsthatthemeasureappliesto,whetherthemeasureappliestoStage4/Universalreportingbyhospitalsandthefinancialincentiveawardaseitherpayforreportingorpayforperformance(P4P).

Thefollowingfields,asdefinedhere,areincludedinthemeasurespecificationssheets.Thepossiblefieldentriesareindicated.1. Measure–providesthenameofthemeasure.

2. DSRIP#–providestheoverallDSRIPprogramnumber.Astherearesomemeasuresthatare

representedinbothStage3andStage4Catalogues,thisisauniquenumberthatcanquicklyidentifythemeasurefortrackingpurposes.

3. MeasureDescription–providesashortexplanationofthepurposeofthemeasure.

4. DataSource–indicatesthemethodofthedatacollection.

a. Chart/EHRb. MMIS

5. NQF#–theNationalQualityForum(NQF)isanon‐profitorganizationthatendorsesand

publiclyreportshealthcarequalitymeasurespecifications.IftheNQFhasendorsedameasure,theNQFisprovidedtoassistthehospitalindeterminingwhetherthehospitalcurrentlycollectsandreportsthemeasureforotherprograms.

6. MeasureSteward–themeasurestewardisthehealthcareentitythatdevelopedandmaintainstheoriginalmeasurespecifications.Thisinformationisprovidedtoassistthehospitalindeterminingwhetherthehospitalcurrentlycollectsandreportsthemeasurefor



otherprograms.Themeasurestewardprovidesthedetailedspecificationinformationregardingthemeasurethatshouldbereviewedtosupportthehospital’smeasurementprocesses.

7. MeasureStewardVersion–throughthemeasuremaintenanceprocess,measure

specificationsareadjustedandrefinedbasedonthemostcurrentlyavailableclinicalandtechnicalinformation.Thisresultsindifferentspecificationversionsinuseforthesamemeasure.ToensurethathospitalscancomparetheDSRIPmeasurespecificationtothemeasuresteward’sversion,theversionnumberisprovided.Whencodeswerereferencedfrommultipleversionsofthemeasure,thesourceforeachcodetypeisnoted.

8. Numerator–definesthespecificcriteriathatidentifiestheportionofthepatientpopulation

thatmeetthespecificperformancemeasurement.

9. Denominator–definesthegeneralcriteriawhichidentifiesthepatientpopulationeligibleformeasurement.

10. Result–thecalculatedperformance.Thiscanbeexpressedaseitherarateorpercentage.

a. Percentage–thisisthemostcommonlyusedindicatorofhealthcaretomonitormeasurecompliance.Apercentagemeasuresthenumberofacertainsetofeventsthatareproportionaltooneanother.Thenumeratoranddenominatorarethesameunitofmeasurementandthenumeratorisasubsetofthedenominator.

b. Rate–thisisaspecifickindofratio,inwhichtwomeasurementsarerelatedtoeachotherbutdonotutilizethesameunitofmeasurement.Thenumeratorisnotasubsetofthedenominatorwhenarateiscalculated.Aratemeasuresthenumberofeventscomparedtoanotherunitofmeasurement,forexampletheutilizationpermembermonths.

11. SettingofCare–thisfieldlistswheretheservice(s)wasrenderedandhelpsidentifywhich

providertypehastheinformationavailable.a. InpatientorEmergencyDepartmentSetting–thisreferstoanymeasurethatonly

considerscarethatwasprovidedwithintheinpatientoremergencydepartmentsettingandisinformationavailabletothehospital.

b. OutpatientSetting–thisreferstoanymeasurethatonlyconsiderscarethatwasprovidedinanoutpatientsetting.Thisinformationmaybeavailableatthehospital‐basedcliniciftheserviceisoffered,orthecommunity‐basedreportingpartner.

c. Multi‐Setting–thisreferstoanyMMISmeasurethatconsiderscarethatwasreceivedacrossmultiplecaressettings.

12. MeasureQualifications–thisfieldallowsforadditionalinformationtobeincludedinthemeasurespecification.Thismayincludesuchinformationaslinkstothemeasuresteward,referencestousageofthemeasureinotherdatasets,oritmayindicatewheretheoriginal



specificationwasadjustedtomoreaccuratelyfollowtheobjectivesoftheDSRIPprogram(e.g.changestomeasurestratifications).

13. ExperiencePeriod–thisfield,otherwiseknownasthemeasurementorperformanceperiod,

indicatesthespecificintervaloftimethataservicemusttakeplacewithininordertobeconsideredomeetthemeasurecriteria.

a. Calendaryear–AnnualDSRIPmeasurementwillbebasedonthecalendaryearascomparedtothefederalfiscalyearorstatefiscalyearassomemeasuresetsallow.

b. Six(6)months–Semi‐annualDSRIPmeasurementwillbebasedonsixmonthsofcalendaryeardata.

14. BaselinePeriod–thisisthetimeperiodforwhichthefirstmeasurementwillbereportedand

subsequentperformancemeasuredagainst.Eachmeasure’sdatasourceandexperienceperiodwillimpactthebaselineperiod.TheMMISbaselineperiodwillinitiallybe20163tosettheoverallmeasureimprovementtargetgoal(ITG).

15. ImprovementTargetGoal(ITG)–theimprovementtargetgoalservesasthestandardlevelof

performancethatNewJerseyhospitalswillstrivetoobtain.Note:ITG’shavebeenremovedfromthisdocumentandcanbeenviewedontheNewJerseyDSRIPwebsite:(https://dsrip.nj.gov/)>DSRIPProgramManagement>MeasureResults(afterloggingin).

16. AbsoluteITGValue–thisfieldrepresentstheabsolutenumericvaluerepresentedforthe

improvementtargetgoal.Note:AbsoluteITGValueshavebeenremovedfromthisdocumentandcanbeenviewedontheNewJerseyDSRIPwebsite.

17. AttributionDate–thisfieldindicateswhetherattributionappliestothemeasure,andifso,will

indicatethattheattributiondatethatimpactstheperformancemeasurecanbenoearlierthanthelastdayoftheexperienceperiod.Note:TheattributiondatehasbeenremovedfromthisdocumentandcanbeenviewedontheNewJerseyDSRIPwebsite.

18. AnchorDate–indicateswhetherameasurerequiresapatienttobeeligibleonaparticular

dateinordertobeincludedinthedenominatorpopulation.Note:Theanchordatehasbeenremovedfromthisdocument.

19. ClaimType(s)–theclaimtyperepresentsrequireddatacomponentsutilizedforthe

adjudicationofaclaimforpayment.TheNewJerseyclaimtypevaluesthatwereusedforprogrammingtheMMISmeasuresareidentifiedforeachMMISmeasure.

20. ContinuousEligibility–thisfieldindicateswhethercontinuouseligibilityappliestothe

measure.Ifitdoesnot,NAwillbemarked.

21. RiskAdjustment–thisfieldindicateswhetherriskadjustmentappliestothemeasure.Ifitdoesnot,NAwillbemarked.



22. Sampling–thisfieldindicateswhethersamplingappliestothemeasure.Ifitdoesnot,NAwill

bemarked.

23. ContinuousEligibility/RiskAdjustment/SamplingMethodology–thisfieldprovidesinstructionsifanyoftheseelementsapplytothemeasure.

24. ProjectTitle–ifthemeasureappliestoaStage3project,thisfielddenotestheapplicable

project(s).

25. ProjectCode–ifthemeasureappliestoaStage3project,thisfielddenotestheprojectcodereferredtowithintheStage3measurecatalogue.

26. PaymentMethod–ifthemeasureappliestoaStage3project,thisfielddenoteswhetherthe

incentiveawardisbasedonpayforreporting,orpayforperformance(P4P).

27. UniversalMeasure–thisfieldindicateswhetherthemeasureappliestoStage4reporting.Ifitdoesnot,NAwillbemarked.

28. UniversalCode–ifthemeasureappliestoStage4reporting,thisfielddenotestheprojectcode

referredtowithintheStage4measurecatalogue.

29. PaymentMethod–ifthemeasureappliestoStage4reporting,thisfielddenoteswhethertheincentiveawardisbasedonpayforreporting,orappliestotheuniversalperformancepool(UPP).

30. DataElements–TheDataElementssectionofsomeofthechart‐basedmeasuresisdesignedtobeastartingpointfordatacollectionfromthemedicalchartand/orelectronichealthrecord(EHR).Asitmaynotbeinclusiveofeveryitemneededtoreportthemeasureaccuratelyandcompletely,athoroughstudyofthemeasure’snumeratoranddenominator,inclusionandexclusioncriteriaandcollectionprocedureswillberequiredtodetermineallofthedataelementsneededfromthemedicalchartortheEHR.



i. GlossaryofAcronyms

Thefollowinglistincludestheacronymscommonlyusedinthisdocument:

ACO - Accountable Care Organization

AHRQ – Agency for Healthcare Research and Quality

AMA – American Medical Association

AMA- PCPI – American Medical Association – Physician Consortium for Performance Improvement

AP‐DRG–AllPatientsDiagnosesRelatedGroups CDC – Centers for Disease Control and Prevention

CHIP – Children’s Health Insurance Program

CMS – Centers for Medicare & Medicaid Services

CPT – Current Procedural Terminology

CQAIHM – Center for Quality Assessment and Improvement in Mental Health

DMAHS - New Jersey Department of Medical Assistance and Human Services

DSRIP – Delivery System Reform Incentive Payment

E&M - Evaluation and Management

ED - Emergency Department

EHR – Electronic Health Record

FQHC - Federally Qualified Health Center

HAB – HIV/AIDS Bureau

HRSA – Health Resources and Services Administration

ICD‐09‐CMandICD‐10‐CM–InternationalClassificationofDiseases,ClinicalModification

ICSI – Institute for Clinical Systems Improvement

ITG - Improvement Target Goal

MCHB – Maternal and Child Health Bureau

MCO - Managed Care Organization

MNCM – Minnesota Community Measurement

MMIS – Medicaid Management Information System

MSIS - Medicaid Statistical Information System

NCQA – National Committee for Quality Assurance

NQF - National Quality Forum

P4P – Pay for Performance

P4R – Pay for Reporting

RSRR - Risk-Standardized Readmission Rate

UB - Universal Bill

*IMPORTANTNOTEFORMEASURESPECIFICATIONS:



Themeasurestewardshouldbereferredtofordetailedanalysis,flowchartsandspecifications.TheDSRIPspecificationsheetprovidesthehighlevelrequirementsforcollectionandreportingforDSRIP.Themeasurestewardoffersfurtherdetailsandrationalethatmaybeimportantforthehospitaltoreview.



Measure:

AntenatalSteroids

DSRIP#:10

MeasureDescription:Thismeasureassessespatientsatriskofpretermdeliveryat≥24and<34weeksgestationreceivingantenatalsteroidspriortodeliveringpretermnewborns.DataSource:

Chart/EHRNQF#:

0476

MeasureSteward:JointCommission

MeasureStewardVersion:2017B1

MeasureCalculationDescriptionNumerator:Patientswithantenatalsteroidtherapyinitiatedpriortodeliveringpretermnewborns.Antenatalsteroidtherapyinitiated‐Initialantenatalsteroidtherapyis12mgbetamethasoneIMor6mgdexamethasoneIM.Table10.1:Medicationsindicatingantenatalsteroidtherapy:(AppendixA‐25)

Medication Generic

Betamethasone Betamethasone

BetamethasoneSodiumPhosphate BetamethasoneSodiumPhosphate

BetamethasoneSodiumPhosphateandBetamethasoneAcetate

BetamethasoneSodiumPhosphateandBetamethasoneAcetate

Celestone Betamethasone

CelestonePhosphate BetamethasoneSodiumPhosphate

CelestoneSoluspan BetamethasoneSodiumPhosphateandBetamethasoneAcetate

Cortastat DexamethasoneSodiumPhosphate

Dalalone DexamethasoneSodiumPhosphate

DalaloneDP DexamethasoneAcetate

DalaloneLA DexamethasoneAcetate

Decadron Dexamethasone

DecadronLA DexamethasoneAcetate

DecadronPhosphate DexamethasoneSodiumPhosphate

Decadronw/Xylocaine DexamethasoneSodiumPhosphatewithLidocaineHCL

Decaject DexamethasoneSodiumPhosphate

DecajectLA DexamethasoneSodiumPhosphate

Dexamethasone Dexamethasone

DexamethasoneAcetate DexamethasoneAcetate

DexamethasoneIntensol Dexamethasone

DexamethasoneSodiumPhosphate DexamethasoneSodiumPhosphate



DexamethasoneSodiumPhosphatewithLidocaine DexamethasoneSodiumPhosphatewithLidocaine

DexamethasoneSodiumPhosphatewithLidocaineHCL

DexamethasoneSodiumPhosphatewithLidocaineHCL

Dexasone DexamethasoneSodiumPhosphate

DexasoneLA DexamethasoneAcetate

Dexone Dexamethasone

DexoneLA DexamethasoneAcetate

Hexadrol Dexamethasone

HexadrolPhosphate DexamethasoneSodiumPhosphate

Solurex DexamethasoneSodiumPhosphate

SolurexLA DexamethasoneAcetate

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thosepatientswhoare8to64yearsofagedeliveringlivepretermnewborns(AppendixA‐22)with>=24and<34weeksgestationcompleted(AppendixA‐23).Exclusion(s):

1. Lessthan8yearsofage.2. Greaterthanorequalto65yearsofage.3. LengthofStay>120days.4. Enrolledinclinicaltrials.5. DocumentedReasonforNotInitiatingAntenatalSteroidTherapy.6. ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCodeorICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCodes

forfetaldemiseasdefinedasfollows(AppendixA‐24):a. ICD‐9:656.40Intrauterinedeath‐unspb. ICD‐9:656.41Intrauterdeath‐deliverc. ICD‐10:O36.4XX0Maternalcareforintrauterinedeath,notapplicableorunspecified

7. GestationalAge<24or>=34weeksorunabletodetermine(UTD)(AppendixA‐23).

Result:TheresultisexpressedasapercentageImprovementDirection:Higher

MeasureQualifications:Thismeasureisapartofasetoffivenationallyimplementedmeasuresthataddressperinatalcare(PC‐03:AntenatalSteroids).

DataElements:Numerator:

Antenatalsteroidsinitiated



Denominator:

AdmissionDate BirthDate ClinicalTrial DischargeDate GestationalAge ICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCodes ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCode ReasonforNotInitiatingAntenatalSteroidTherapy

NotesforAbstraction:Ifthereisdocumentationthatantenatalsteroidtherapywasinitiatedpriortocurrenthospitalizationinanothersettingofcare,i.e.,doctor'soffice,clinic,birthingcenter,hospitalbeforedelivery,selectallowablevalue"yes".Ifantenatalsteroidtherapywasinitiatedinthehospital,thenameofthemedicationmustbedocumentedinthemedicalrecordinordertoselectallowablevalue"yes".

Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualificationsanddatacollection.Thisisprovidedwithoutassurances:

http://www.jointcommission.org/core_measure_sets.aspx

MeasureCollectionDescriptionSettingofCare:

InpatientorEmergencyDepartmentReportingPeriod:

Annual;AprilExperiencePeriod:

CalendarYear BaselinePeriod:

CY2014CY2016RiskAdjustment:

NoSampling:

YesSamplingorRiskAdjustmentMethodology

ThismeasureistobecollectedandreportedbythehospitalfollowingthesamplingguidanceprovidedinSectionIII.

DSRIPIncentiveImpactProjectTitle:NA

ProjectCode:NA

Payment Method:NA

UniversalMeasure:Yes

UniversalCode:29

PaymentMethod:PayforReporting



Measure:

BipolarDisorderandMajorDepression:Appraisalforalcoholorchemicalsubstanceuse

DSRIP#:15

MeasureDescription:PercentageofpatientswithdepressionorbipolardisorderwithevidenceofaninitialassessmentthatincludesanappraisalforalcoholorchemicalsubstanceuseDataSource:

Chart/EHRNQF#(Nolongerendorsed):

0110

MeasureSteward:CQAIHM

MeasureStewardVersion:2007

MeasureCalculationDescriptionNumerator:Patientswithevidenceofanassessmentforalcoholorothersubstanceusefollowingorconcurrentwiththenewdiagnosisandpriortoorcurrentwiththeinitiationoftreatmentforthatdiagnosis.NumeratorInclusionCriteria:Documentedassessmentforuseofalcoholandchemicalsubstanceuse;toincludeatleastoneofthefollowing:

1. Cliniciandocumentationregardingpresenceorabsenceofalcoholandchemicalsubstanceuse.2. Patientcompletedhistory/assessmentformthataddressesalcoholandchemicalsubstanceuse

thatisdocumentedasbeingnoted/acknowledgedbyclinicianperformingtheassessment.3. Useofscreeningtoolsthataddressalcoholandchemicalsubstanceuse.

ANDTimeframe:Documentationoftheassessmentforalcoholandchemicalsubstanceusemustbepresentpriorto,orconcurrentwith,thevisitwherethediagnosisand/ortreatmentplanisfirstdocumented.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thosepatients18yearsofageorolderatthestartofthemeasurementperiodwithanewdiagnosisofunipolardepressionorbipolardisorderduringthefirst323daysofthemeasurementperiod,andevidenceoftreatmentforunipolarorbipolardisorderwithin42daysofdiagnosis.Theexistenceofa‘newdiagnosis’isestablishedbytheabsenceofdiagnosesandtreatmentsofunipolardepressionorbipolarduringthe180dayspriortothediagnosis.DenominatorInclusionCriteria:

1. Documentationofadiagnosisinvolvingunipolardepressionorbipolardisordertoincludeatleastoneofthefollowing:a. Documentationofadiagnosisorimpressioninvolvingunipolardepression(Table15.1)or

bipolardisorder(Table15.2);documentedinthebodyofachart,suchasapre‐printedformcompletedbyaclinicianand/orcodesdocumentedinchartnotes/form



b. Useofascreening/assessmenttoolforunipolardepressionorbipolardisorderwithascoreorconclusionthatpatienthasunipolardepressionorbipolardisorderandindicationthatthisinformationisusedtoestablishorsubstantiatethediagnosis

Table15.1:CodestoIdentifyUnipolarDepression(AppendixA‐26)

Description CodeType CodeUnipolarDepression ICD‐9‐CM ‐296.20‐296.26,296.30‐296.36,300.4,311

ICD‐10‐CM F32.0‐F32.9,F33.0‐F33.3,F33.9,F33.41,F33.42,F34.1

Table15.2:CodestoIdentifyBipolarDisorder(AppendixA‐27)

Description CodeType CodeBipolarDisorder ICD‐9‐CM 296.00‐296.06,296.10‐296.16,296.40‐296.46,296.50‐

296.56,296.60‐296.66,296.7,296.80‐296.82296.89,301.13ICD‐10‐CM F30.10‐F30.13,F30.2‐F30.4,F30.8,F31.10‐F31.13,F31.2,

F31.30‐F31.32,F31.4,F31.5,F31.60‐F31.64,F31.73‐F31.78,F31.81,F31.9,F32.8,F34.0

Result:Theresultisexpressedasapercentage.ImprovementDirection:Higher

MeasureQualifications:

DataElements:Numerator

AlcoholandChemicalSubstanceUseAssessmentDenominator

BirthDate ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCode DateofICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCode ICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCode DateofICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCode DocumentationSource

Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualificationsanddatacollection.Thisisprovidedwithoutassurances:

http://www.cqaimh.org/measure_SU.html

MeasureCollectionDescription



SettingofCare:OutpatientSetting

ReportingPeriod:Annual;April

ExperiencePeriod:CalendarYear

BaselinePeriod:CY2014CY2016

RiskAdjustment:No Sampling:Yes

SamplingorRiskAdjustmentMethodology


DSRIPIncentiveImpactProjectTitle:Project3‐IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)

ProjectCode:3.8

PaymentMethod:P4P

ProjectTitle:Project5‐ElectronicSelf‐AssessmentDecisionSupportTool

ProjectCode:5.2


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

CAC‐1:RelieversforInpatientAsthma

DSRIP#:17

MeasureDescription:Children’sAsthmaCare(CAC)measurementoftheuseofrelieversinpediatricpatientsadmittedforinpatienttreatmentofasthma.DataSource:

Chart/EHRNQF#(nolongerendorsed):

0143


MeasureStewardVersion:Version4.3b

MeasureCalculationDescriptionNumerator:Pediatricasthmainpatientpatientswhoreceivedrelievers(Table17.1)duringhospitalization.Table17.1:RelieverMedications(AppendixA‐44)

Medication Generic

Accuneb AlbuterolSulfate

Adrenaclick Epinephrine

Adrenaline Epinephrine

Albuterol/Ipratropium Albuterol/Ipratropium

AlbuterolSulfate AlbuterolSulfate

AtroventHFA IpratropiumBromide

Combivent Albuterol/Ipratropium

DuoNeb Albuterol/Ipratropium

Epinephrine Epinephrine

Epipen Epinephrine

EpipenJR Epinephrine

IpratropiumBromide IpratropiumBromide

Isoproterenol Isoproterenol

Isuprel Isoproterenol

LevalbuterolHydrochloride LevalbuterolHydrochloride

MaxairAutohaler PirbuterolAcetate

Maxair PirbuterolAcetate

Metaproterenol Metaproterenol

PirbuterolAcetate PirbuterolAcetate

ProAirHFA AlbuterolSulfate

ProventilHFA AlbuterolSulfate



RelieverNotOtherwiseSpecified(NOS) None

Terbutaline Terbutaline

Twinject Epinephrine

VentolinHFA AlbuterolSulfate

Xopenex LevalbuterolHydrochloride

XopenexHFA LevalbuterolHydrochlorideTheresultsarestratifiedby:

1. Overallrate(Age2yearsthrough17years)2. Age2yearsthrough4years3. Age5yearsthrough12years4. Age13yearsthrough17years

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thosepediatricpatientsaged2through17yearsofagewhoweredischargedwithaprincipaldiagnosisofasthma.(Table17.2)Table17.2:CodestoIdentifyAsthma(AppendixA‐45)

Description CodeType Codes

Asthma

ICD‐9‐CM 493.00‐493.02,493.10‐493.12,493.81,493.82,493.90‐493.92ICD‐10‐CM J4520‐J4522,J4530‐J4532,J4540‐J4542,J4550‐J4552,J45901,J45902,

J45909,J45990,J45990,J45991,J45998Exclusion(s):

1. PatientswithadocumentedReasonForNotAdministeringRelievers.2. Patientsenrolledinclinicaltrials.3. Patientswithalengthofstaygreaterthan120days.4. Patientswithagelessthan2yearsor18yearsorgreater.



ForthepurposesoftheCACmeasures,inpatienthospitalizationincludesthetimeofarrivaltotheemergencydepartment(ED)orobservationareauntildischargefromtheinpatientsetting.

DataElements

Numerator: RelieversAdministered



Denominator: AdmissionDate BirthDate ClinicalTrial ReasonforNotAdministeringRelievers DischargeDate ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCode

PatientageiscalculatedbyAdmissionDate–BirthDateaspartoftheICDpopulationlogic”frompage8ofthestewarddocument.Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances:

http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatientquality_measures.aspxhttps://manual.jointcommission.org/releases/Archive/TJC2010B1/MIF0115.html



1stSemi‐Annual=April2ndSemi‐Annual=October

ExperiencePeriod:Quarterly

BaselinePeriod:SAJuly–December20142016



Forhospitalsselectingsamplecasesforstratifiedmeasuresetsormeasuresetswithsub‐populations(CACandVTE),amodifiedsamplingprocedureisrequired.Hospitalsselectingsamplecasesforthesesetsmustensurethateachindividualstratum’spopulation/sub‐populationandsamplesizemeetstheconditionsstatedinthemeasureset’sSampleSizeRequirements.(SeeVTEandCACsamplerequirementsfromtheJointCommission.Onceelectronicmanualisopen,methodologycanbefoundonthefollowingdocument:2zc_CAC_List)

Hospitalswillfollowthequarterlysamplingguidelinesthencollectandreportthedataonasemi‐annualbasis.Thetwoquarterswillbesummedforthefinalresult.

DSRIPIncentiveImpact

ProjectTitle:Project1–Hospital‐BasedEducatorsTeachOptimalAsthmaCare

ProjectCode:1.1


ProjectTitle:Project2–PediatricAsthmaCaseManagementandHomeEvaluations

ProjectCode:2.1


UniversalMeasure:NA

UniversalCode:NA

PaymentMethod:NA



MeasureName

CAC‐2:SystemicCorticosteroidsforInpatientAsthma

DSRIP#18

MeasureDescription:Useofsystemiccorticosteroidsinpediatricpatientsadmittedforinpatienttreatmentofasthma.

DataSource:Chart/EHR

NQF#(nolongerendorsed):0144


MeasureStewardVersion:Version4.3b

MeasureCalculationDescriptionNumerator:Pediatricasthmapatientswhoreceivedsystemiccorticosteroidsduringhospitalization.

Patientswhowereadministeredsystemiccorticosteroids(Table18.1)duringthishospitalization.Table18.1SystemicCorticosteroidMedications(AppendixA‐46)

Medication GenericFlo‐pred PrednisoloneAcetateHydrocortisone HydrocortisoneHydrocortisoneSodiumSuccinate HydrocortisoneSodiumSuccinateKenalog TriamcinoloneAcetonideMedrol MethylprednisoloneMedrolDosepak MethylprednisoloneMethylprednisolone MethylprednisoloneMethylprednisoloneAcetate MethylprednisoloneAcetateMethylprednisoloneSodiumSuccinate MethylprednisoloneSodiumSuccinateMillipred PrednisoloneOrapred PrednisoloneOrapredODT PrednisolonePediapred PrednisolonePrednisolone PrednisolonePrednisoloneAcetate PrednisoloneAcetatePrednisoneIntensol PrednisonePrednisoloneSodiumPhosphate PrednisoloneSodiumPhosphatePrednisone PrednisonePrelone PrednisoloneSolu‐Cortef HydrocortisoneSodiumSuccinateSterapred PrednisoneSystemicCorticosteroidNotOtherwiseSpecified(NOS)

None

TriamcinoloneAcetonide TriamcinoloneAcetonideVeripred20 PrednisoloneHospitalsresultswillbestratifiedby:

1. Overallrate(2through17years)2. Age2yearsthrough4years3. Age5yearsthrough12years



4. Age13yearsthrough17years

Denominator:OftheNewJerseyLowIncomeattributedpopulation,pediatricpatientsaged2through17yearsofagewhoweredischargedwithaprincipaldiagnosisofasthma.(Table18.2) Table18.2:CodestoIdentifyAsthma(AppendixA‐45)

Description CodeType Codes

Asthma

ICD‐9‐CM 493.00‐493.02,493.10‐493.12,493.81,493.82,493.90‐493.92ICD‐10‐CM J4520‐J4522,J4530‐J4532,J4540‐J4542,J4550‐J4552,J45901,J45902,

J45909,J45990,J45990,J45991,J45998DenominatorExclusion(s):

1. PatientswithadocumentedReasonforNotAdministeringSystemicCorticosteriods.2. Patientswithalengthofstaygreaterthan120days.3. Patientsenrolledinclinicaltrials.4. Patientswithagelessthan2yearsor18yearsorgreater.


MeasureQualifications:DataElements:Numerator:

SystemicCorticosteroidsAdministered(Table18.1)Denominator:

AdmissionDate BirthDate ICD‐9‐CMPrincipalDiagnosisCode ClinicalTrials DischargeDate ReasonfornotAdministeringSystemicCorticosteroids

PatientageiscalculatedbyAdmissionDate–BirthDateaspartoftheICDpopulationlogic”frompage8ofthestewarddocument.Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances:



http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatientquality_measures.aspxhttps://manual.jointcommission.org/releases/archive/TJC2010B1/MIF0114.html








Forhospitalsselectingsamplecasesforstratifiedmeasuresetsormeasuresetswithsub‐populations(CACandVTE),amodifiedsamplingprocedureisrequired.Hospitalsselectingsamplecasesforthesesetsmustensurethateachindividualstratum’spopulation/sub‐populationandsamplesizemeetstheconditionsstatedinthemeasureset’sSampleSizeRequirements.(SeeVTEandCACsamplerequirementsfromtheJointCommission.Onceelectronicmanualisopen,methodologycanbefoundonthefollowingdocument:2zc_CAC_List)

Hospitalswillfollowthequarterlysamplingguidelinesthencollectandreportthedataonasemi‐annualbasis.Thetwoquarterswillbesummedforthefinalresult.



ProjectCode:1.2


Project2–PediatricAsthmaCaseManagementandHomeEvaluations

2.2 PayforReporting

UniversalMeasure:NA

UniversalCode:NA

PaymentMethod:NA



Measure:

Cardiovascularhealthscreeningforpeoplewithschizophreniaorbipolardisorderwhoareprescribedantipsychoticmedicines

DSRIP#:94

MeasureDescription:Thepercentageofpatients25to64yearsofagewithschizophreniaorbipolardisorderwhowereprescribedanyantipsychoticmedicationandwhoreceivedacardiovascularhealthscreeningduringthemeasurementyear.DataSource:

Chart/EHRNQF#:

1927

MeasureSteward:NCQA

MeasureStewardVersion:2017‐7.1

MeasureCalculationDescriptionNumerator:IndividualswhohadoneormoreLDL‐Cscreeningsperformedduringthemeasurementyear.(AppendixA‐51)

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patients25to64yearsofagebytheendofthemeasurementyearwithadiagnosisofschizophrenia(AppendixA‐109)orbipolardisorder(AppendixA‐110)whowereprescribedanyantipsychoticmedicationduringthemeasurementyear.(AppendixA‐111)Exclusion(s):

1. Patientsareexcludedfromthedenominatoriftheyweredischargedaliveforacoronaryarterybypassgraft(CABG)(AppendixA‐112)orpercutaneouscoronaryintervention(PCI)(AppendixA‐113)(theseeventsmayoccurinthemeasurementyearortheyearpriortothemeasurementyear).

2. Patientsdiagnosedwithischemicvasculardisease(IVD)(AppendixA‐114)(thisdiagnosismustappearinboththemeasurementyearandtheyearpriortothemeasurementyear)

3. Patientdiagnosedwithchronicheartfailure(AppendixA‐115),orhadapriormyocardialinfarction(AppendixA‐116)(identifiedinthemeasurementyearorasfarbackaspossible).


MeasureQualifications:Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualificationsanddatacollection.Thisisprovidedwithoutassurances:

http://www.qualityforum.org/QPS/1927




OutpatientReportingPeriod:



CY2014CY2016RiskAdjustment:No Sampling:Yes



DSRIPIncentiveImpactProjectTitle:Project3–IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)

ProjectCode:Substitutionmeasure

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

CentralLine‐AssociatedBloodstreamInfection(CLABSI)Event

DSRIP#:21

MeasureDescription:CLABSIrate,expressedper1,000centrallinedays.DataSource:

Chart/EHRNQF#:

Basedon0139

MeasureSteward:CDC


MeasureCalculationDescriptionNumerator:Totalnumberofobservedhealthcare‐associatedcentralline‐associatedbloodstreaminfections(CLABSI)amongpatientsinallreportablelocationsincludingICUs,NICUs,SCAsandotheracutecarehospitallocationswherepatientsresideovernight.Abloodstreaminfectionmustfirstbedeterminedtobeahealthcare‐associatedinfection(HAI)beforeitcanbe identifiedasaCLABSI.OnlyHAIscanbeCLABSIs.AnHAI isa localizedorsystemicconditionresultingfromanadversereactiontothepresenceofaninfectiousagent(s)oritstoxin(s)thatwasnotpresentorincubatingonadmissiontotheacutecarefacility.

NumeratorInclusionCriteria:Alaboratory‐confirmedbloodstreaminfection(LCBI)whereacentralline(CL)orumbilicalcatheter(UC)wasinplace>2calendardaysonthedateofevent,withdeviceplacementbeingDay1,ANDacentralline(CL)orumbilicalcatheter(UC)wasinplaceonthedateofeventorthedaybefore.IfaCLorUCwasinplacefor>2calendardaysandthenremoved,theLCBIcriteriamustbefullymetonthedayofdiscontinuationorthenextday.Ifthepatientisadmittedortransferredintoafacilitywithcentrallineinplace(e.g.tunneledorimplantedcentralline),dayoffirstaccessisconsideredDay1.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thetotalnumberofcentrallinedevicedaysforalllocationsundersurveillanceforCLABSI.

Result:Theresultisexpressedasarate.TherateiscalculatedasthenumberofidentifiedCLABSIeventsoverthenumberofcentrallinedevicedaysmultipliedby1000.ImprovementDirection:Lower



MeasureQualifications:SeemeasurestewardspecificationformoredetailsonhowtoidentifyCLABSIevents.Definitionofdevicedays:adailycountofthenumberofpatientswithaspecificdevice(i.e.centralline)inplaceinapatientcarelocation.DevicedaysareusedfordenominatorsinCLABSIrates.Devicedaydenominatordatathatarecollecteddifferaccordingtothelocationofthepatientsbeingmonitored.a.ForICUs,thenumberofpatientswithoneormorecentrallinesofanytypeiscollecteddaily,atthesametimeeachdayduringthemonth.Thetotalsforthemonthareentered.b.InNICUs,thenumberofpatientswithoneormorecentrallines(includingumbilicalcatheters)isstratifiedbybirthweightinfivecategoriessinceriskofBSIvariesbybirthweight.IntensiveCareUnit–Anursingcareareainwhichatleast80percentofthepatientsmatchdefinitionsofcriticalcarelocationsfoundinchapter15,MasterCDCLocationsandDescriptions,oftheNHSNPatientSafetyComponentManual.http://www.cdc.gov/nhsn/PDFs/pscManual/15LocationsDescriptions_current.pdfCentralLine–Anintravascularcatheterthatterminatesatorclosetotheheartorinoneofthegreatvesselswhichisusedforinfusion,withdrawalofblood,orhemodynamicmonitoring.ThefollowingareconsideredgreatvesselsforthepurposeofreportingCLABSIandcountingcentral‐linedays:

• Aorta,pulmonaryartery,superiorvenacava,inferiorvenacava,brachiocephalicveins,internaljugularveins,subclavianveins,externaliliacveins,commoniliacveins,femoralveinsandinneonates,theumbilicalartery/vein.Note:Neithertheinsertionsitenorthetypeofdevicemaybeusedtodetermineifalinequalifiesasacentralline.Thedevicemustterminateinoneofthegreatvesselsorinorneartheheartandbeusedforoneofthepurposesoutlinedabovetoqualifyasacentralline.

Infusion–Theintroductionofasolutionthroughabloodvesselviaacatheterlumen.Thismayincludecontinuousinfusionssuchasnutritionalfluidsormedications,oritmayincludeintermittentinfusionssuchasflushesorIVantimicrobialadministration,orblood,inthecaseoftransfusionorhemodialysis.Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualificationsanddatacollection.Thisisprovidedwithoutassurances:

http://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf


SettingofCare:InpatientorEmergencyDepartment










ProjectCode:NA

PaymentMethod:NA


UniversalCode:36

PaymentMethod:UPP



Measure:

CesareanRateforNullipariousSingletonVisits

DSRIP#:23

MeasureDescription:Nulliparouswomenwithaterm,singletonbabyinavertexpositiondeliveredbycesareansection.DataSource:

Chart/EHRNQF#:

0471


MeasureStewardVersion:v2017B1

MeasureCalculationDescriptionNumerator:Patientswithcesareansections.(Table23.1)Table23.1:CodestoIdentifyCesareanSection(AppendixA‐47)

CodeType CodesICD‐9‐PCS 74.0,74.1,74.2,74.4,74.99ICD‐10‐PCS 10D00Z0,10D00Z1,10D00Z2

Denominator:OftheNewJerseyLowIncomeattributedpopulation,nulliparouspatientsdeliveredofalivetermsingletonnewborninvertexpresentation.Includenulliparouspatientswithcodesforoutcomeofdelivery(Table23.2)withadeliveryofanewbornwith37weeksormoreofgestationcompleted(AppendixA‐23).Table23.2:CodestoIdentifyOutcomeofDelivery(AppendixA‐48)

CodeType CodesICD‐9‐CM V27.0ICD‐10‐CM Z370

Exclusion(s):

1. Patientslessthan8yearsofage2. Patientsgreaterthanorequalto65yearsofage3. LengthofStay>120days4. Patientsenrolledinclinicaltrials5. Gestationalage<37weeksorunabletodetermine(UTD)(AppendixA‐23)6. Patientswithcodesformultiplegestationsandotherpresentations(AppendixA‐49)

Result:Theresultisexpressedasapercentage.



Improvementdirection:Lower

MeasureQualifications/Definitions:

DataElements:

AdmissionDate Birthdate ClinicalTrial DischargeDate GestationalAge ICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCodes ICD‐9‐CM/ICD‐10‐CMOtherProcedureCodes ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCodes ICD‐9‐CM/ICD‐10‐CMPrincipalProcedureCodes Parity

Thismeasureisapartofasetoffivenationallyimplementedmeasuresthataddressperinatalcare(PC‐02:CesareanSection,PC‐03:AntenatalSteroids,PC‐04:HealthCare‐AssociatedBloodstreamInfectionsinNewborns,PC‐05:ExclusiveBreastMilkFeeding).

Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecification.Thisisprovidedwithoutassurances:

http://manual.jointcommission.org/releases/TJC2013B/MIF0167.html






RiskAdjustment/SamplingMethodology



ProjectCode:NA

PaymentMethod:NA


UniversalCode:40

PaymentMethod:UPP



Measure:

ChildrenAge6–17YearswhoEngageinWeeklyPhysicalActivity

DSRIP#:26

MeasureDescription:Percentageofpatients6‐17yearsofagethatparticipateinatleast60minutesofphysicalactivityatleast3timesaweek.DataSource:

Chart/EHRNQF#:

1348

MeasureSteward:CDC


MeasureCalculationDescriptionNumerator:Numberofpatientsthatparticipateinatleast60minutesofphysicalactivityatleast3timesaweek.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,children6‐17yearsofageasoftheendofthemeasurementperiod.



Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualifications/definitionsanddatacollection.Thisisprovidedwithoutassurances:

http://www.cdc.gov/healthyschools/physicalactivity/guidelines.htm




ExperiencePeriod:6monthperiod


RiskAdjustment:No Sampling:No




NADSRIPIncentiveImpact

ProjectTitle:Project15‐After‐SchoolObesityProgram

ProjectCode:15.4

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

ComprehensiveDiabetesCare:LDL‐CControl<100mg/DL

DSRIP#:30

MeasureDescription:Percentageofpatients18to75yearsofagewithdiabetes(type1andtype2)whoselowdensitylipoproteincholesterol(LDL‐C)leveliscontrolled(lessthan100mg/dL).DataSource:

Chart/EHRNQF#:

Basedon0064MeasureSteward:

NCQAMeasureStewardVersion:

2014MeasureCalculationDescription

Numerator:PatientswhosemostrecentLDL‐Cscreening,performedduringthemeasurementyear,islessthan100mg/dL.

Table30.1:CodestoIdentifyLDL‐CScreening(AppendixA‐51)CPT CPTCategoryII LOINC

80061,83700,83701,83704,83721

3048F,3049F,3050F 2089‐1,12773‐8,13457‐7,18261‐8,18262‐6,22748‐8,39469‐2,49132‐4,55440‐2,69419‐0

NumeratorExclusionsCriteria

TheresultofthemostrecentLDL‐Cscreeningis≥100mg/dL TheresultofthemostrecentLDL‐Cscreeningismissing AnLDL‐Cscreeningwasnotperformed

Table30.2:CodestoIdentifyLDL‐CLevels

Description CPTCategoryII

Numeratorcompliant(LDL‐C<100mg/dL) 3048F

Notnumeratorcompliant(LDL‐C≥100mg/dL)LDL‐C≥ 3049F,3050F

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patients18to75yearsofagewithdiabetes(type1andtype2)asoftheendofthemeasurementyear.(AppendixA‐28)

Patientswithdiabetesmellitusareidentifiedusingdiagnosiscodesand/orpharmacydatawithintheinpatientoroutpatientclaimsdata.Onlyonemethodtoidentifypatientsisneededtobeincludedinthedenominator.

1. Claimsdata.a. Patientswithatleasttwoface‐to‐faceencounterswithaprincipalorsecondary

diagnosisofdiabetes(AppendixA‐28)withdifferentdatesofserviceinanoutpatientsettingornon‐acuteinpatientsettingduringthemeasurementyear.

b. Patientswithatleastoneface‐to‐faceencounterwithaprincipalorsecondarydiagnosisofdiabetes(AppendixA‐28)inanacuteinpatientoremergencydepartmentsettingduringthemeasurementyear.



2. Pharmacydata.Patientswhoweredispensedinsulinorhypoglycemic/antihyperglycemicson

anambulatorybasisduringthemeasurementyearortheyearpriortothemeasurementyear.(AppendixA‐9)

PrescriptionstoIdentifyMembersWithDiabetes

Description PrescriptionAlpha‐glucosidaseinhibitors

Acarbose Miglitol

Amylinanalogs Pramlinitide

Antidiabeticcombinations

Alogliptin‐metformin Alogliptin‐pioglitazone

Canagliflozin‐metformin

Glimepiride‐pioglitazone

Glimepiride‐rosiglitazone

Glipizide‐metformin

Glyburide‐metformin Linagliptin‐metformin

Metformin‐pioglitazone

Metformin‐repaglinide

Metformin‐rosiglitazone

Metformin‐saxagliptin

Metformin‐sitagliptin Sitagliptin‐simvastatin

Insulin Insulinaspart Insulinaspart‐insulinaspartprotamine

Insulindetemir Insulinglargine Insulinglulisine

Insulinisophanehuman Insulinisophane‐insulinregular Insulinlispro Insulinlispro‐insulinlisproprotamine Insulinregularhuman

Meglitinides Nateglinide RepaglinideGlucagon‐likepeptide‐1(GLP1)agonists

Exenatide Liraglutide Albiglutide

Sodiumglucosecotransporter2(SGLT2)inhibitor

Canagliflozin Dapagliflozin Empagliflozin

Sulfonylureas Chlorpropamide Glimepiride

Glipizide Glyburide

Tolazamide Tolbutamide

Thiazolidinediones Pioglitazone Rosiglitazone

Dipeptidylpeptidase‐4(DDP‐4)inhibitors

Alogliptin Linagliptin

Saxagliptin Sitaglipin

Note:Glucophage/metforminasasoloagentisnotincludedbecauseitisusedtotreatconditionsotherthandiabetes;memberswithdiabetesonthesemedicationsareidentifiedthroughdiagnosiscodesonly.NCQAwillpostacompletelistofmedicationsandNDCcodestowww.ncqa.orgbyNovember2,2015.Exclusion(s):

1. Diagnosisofactivegestationaldiabetesandactivesteroidinduceddiabetes.(AppendixA‐91)




MeasureQualifications:LDL‐Clevelsmaybecalculatedfromtotalcholesterol,HDL‐CandtriglyceridesusingtheFriedewaldequationifthetriglyceridesare≤400mg/dL.

(LDL‐C)=(totalcholesterol)–(HDL)–(triglycerides/5) Iflipoprotein(a)ismeasured,usethefollowingcalculation.

(LDL‐C)=(totalcholesterol)–(HDL)–(triglycerides/5)–0.3[lipoprotein(a)]

Theseformulaeareusedwhenalllevelsareexpressedinmg/dLandcannotbeusediftriglycerides>400mg/dL.TheFriedewaldequationmaynotbeusedifadirectorcalculatedresultispresentinthemedicalrecordforthemostrecentLDL‐Ctest.Pleasenote:NCQAallowsforcollectionofthismeasureinmultiplesettings(inpatientandoutpatient).FortheNJDSRIPprogram,thismeasurewillbecollectedinanoutpatientsettingonly.Thefollowinglinksmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualifications/definitionsanddatacollection.Thisisprovidedwithoutassurances:

http://www.qualitymeasures.ahrq.gov/content.aspx?id=38877&search=ldl‐c+control

http://www.ncqa.org/HEDISQualityMeasurement/HEDISMeasures.aspx





CY20152016RiskAdjustment:No Sampling:Yes



DSRIPIncentive Impact

ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:17




Measure:

ControllingHighBloodPressure(CBP)

DSRIP#:31

MeasureDescription:Percentageofpatients18–85yearsofagewhohadadiagnosisofhypertension(HTN)andwhosebloodpressure(BP)wasadequatelycontrolled(<140/90)duringthemeasurementyear.DataSource:

Chart/EHRNQF#:

0018

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Thenumberofpatientsinthedenominatorwhosemostrecentbloodpressure(BP)isadequatelycontrolledduringthemeasurementyear.AdequateControlForthepatient’sBPtobecontrolled,boththesystolicanddiastolicBPmustbe<140/90(adequatecontrol).Todetermineifapatient’sBPisadequatelycontrolled,therepresentativeBPmustbeidentified.FollowthestepsbelowtodeterminerepresentativeBP:Step1:IdentifythemostrecentBPreadingnotedduringthemeasurementyear.Thereadingmustoccurafterthedatewhenthediagnosisofhypertensionwasmadeorconfirmed.DonotincludeBPreadingsthatmeetthefollowingcriteria:

a. TakenduringanacuteinpatientstayoranEDvisit.b. Takenduringanoutpatientvisitwhichwasforthesolepurposeofhavingadiagnosis

diagnostictestorsurgicalprocedureperformed(e.g.,sigmoidoscopy,removalofamole).c. Obtainedthesamedayasamajordiagnosticorsurgicalprocedure(e.g.,stresstest,

administrationofIVcontrastforaradiologyprocedure,endoscopy).d. Reportedortakenbythepatient.

Step2:IdentifythelowestsystolicandlowestdiastolicBPreadingfromthemostrecentBPnotationinthemedicalrecord.Ifmultiplereadingswererecordedforasingledate,usethelowestsystolicandlowestdiastolicBPonthatdateastherepresentativeBP.Thesystolicanddiastolicresultsdonotneedtobefromthesamereading.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thosepatientsaged18‐85yearsofagewithadiagnosisofhypertension.(AppendixA–55)Patientsareidentifiedashypertensiveifthereisatleastoneoutpatientvisit(AppendixA‐32)withadiagnosisofhypertension(AppendixA‐55)duringthefirstsixmonthsofthemeasurementyear.



Toconfirmthediagnosisofhypertension,theprovidermustfindnotationofoneofthefollowinginthemedicalrecordonorbeforeJune30ofthemeasurementyear:

HTN.

HighBP(HBP).

ElevatedBP(BP).

BorderlineHTN.

IntermittentHTN.

HistoryofHTN.

Hypertensivevasculardisease(HVD).

Hyperpiesia.

Hyperpiesis.

ThenotationofhypertensionmayappearonorbeforeJune30ofthemeasurementyear,includingpriortothemeasurementyear.Itdoesnotmatterifhypertensionwastreatedoriscurrentlybeingtreated.Thenotationindicatingadiagnosisofhypertensionmayberecordedinanyofthefollowingdocuments:

Problemlist(thismayincludeadiagnosispriortoJune30ofthemeasurementyearoranundateddiagnosis;seeNoteattheendofthissection).

Officenote.

Subjective,Objective,Assessment,Plan(SOAP)note.

Encounterform.

Telephonecallrecord.

Diagnosticreport.

Hospitaldischargesummary.

Statementssuchas“ruleoutHTN,”“possibleHTN,”“white‐coatHTN,”“questionableHTN”and“consistentwithHTN”arenotsufficienttoconfirmthediagnosisifsuchstatementsaretheonlynotationsofhypertensioninthemedicalrecord.

Exclusion(s):

1. Excludefromtheeligiblepopulationallpatientswithevidenceofend‐stagerenaldisease(ESRD)(AppendixA‐56)orkidneytransplantonorpriortoDecember31ofthemeasurementyear.DocumentationinthemedicalrecordmustincludeadatednoteindicatingevidenceofESRD,kidneytransplantordialysis.

2. Excludefromtheeligiblepopulationallpatientswithadiagnosisofpregnancy(AppendixA‐50)duringthemeasurementyear.





Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualificationsanddatacollection.Thisisprovidedwithoutassurances:





CalendarYearBaselinePeriod:

Stage3=CY2014CY2016Stage4=CY2015




DSRIPIncentiveImpactProjectTitle:Project6‐CareTransitionsInterventionModeltoReduce30‐DayReadmissionsforChronicCardiacConditions

ProjectCode:6.2


ProjectTitle:Project7‐ExtensivePatientCHF‐FocusedMulti‐TherapeuticModel

ProjectCode:7.3


ProjectTitle:Project8‐TheCongestiveHeartFailureProgram(CHF‐TP)

ProjectCode:8.3


ProjectTitle:Project11‐ImproveOverallQualityofCareforPatientsDiagnosedwithDiabetesMellitusandHypertension

ProjectCode:11.8

PaymentMethod:P4P

ProjectTitle:Project12‐DiabetesGroupVisitsforPatientsandCommunityEducation

ProjectCode:12.6

PaymentMethod:P4P


UniversalCode:NA

PaymentMethod:NA



Measure:

DepressionRemissionat12Months

DSRIP#:33

MeasureDescription:Patientsage18yearsofageorolderwithmajordepressionordysthymiaandaninitialPHQ‐9scoregreaterthan(>)nine(9)whodemonstrateremissionattwelve(12)monthsdefinedasaPHQ‐9scorelessthan(<)five(5).DataSource:

Chart/EHRNQF#:

0710

MeasureSteward:MinnesotaCommunityMeasurement(MNCM)


MeasureCalculationDescriptionNumerator:DepressionpatientswithaninitialPHQ‐9score>ninewhosePHQ‐9scoreat12months(+/‐30days)islessthanfive.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patients18yearsofageorolderasofDecember31ofthemeasurementyearwithanactivediagnosisofmajordepressionordysthymia(AppendixA‐74)andaninitialPHQ‐9score>9whohadavisitorcontactwithaneligibleproviderinaneligiblespecialtyduringthemeasurementyear.Note:Forbehavioralhealthproviders:ThediagnosisofMajorDepressionorDysthymiamustbetheprimarydiagnosis.

Thismeasurecontainsafourteenmonthmeasurementperiodduetothe+/‐30dayperiodonthefrontandbackofthetwelvemonthexperienceperiod.

Eligibleproviders:MedicalDoctor(MD),DoctorofOsteopathy(DO),PhysicianAssistant(PA),AdvancedPracticeRegisteredNurses(APRN).Ifaphysicianisonsite,theseprovidersarealsoeligible:LicensedPsychologist(LP),LicensedIndependentClinicalSocialWorker(LICSW),LicensedProfessionalClinicalCounselor(LPCC),LicensedMarriage&FamilyTherapist(LMFT).Eligiblespecialties:FamilyMedicine,InternalMedicine,GeriatricMedicine,Psychiatry,andBehavioralHealth.

Themeasurementperiodisafixedtwelve(12)monthperiod.Inordertocollectdatatocalculateremissionattwelve(12)months,patientvisitswillneedtobetrackedtheyearpriortothemeasurementperiod.

Exclusion(s):1. Patientwasapermanentnursinghomeresidentduringthemeasurementperiod.2. Patientwasinhospiceorreceivingpalliativecareatanytimeduringthemeasurementperiod.3. Patientdiedpriortotheendofthemeasurementperiod.4. Patienthasdiagnosisofbipolar(AppendixA‐75)orpersonalitydisorder(AppendixA‐76).







http://mncm.org/wp‐content/uploads/2015/12/Depression‐Care‐Measures‐2016‐Data‐Collection‐Guide‐FINAL‐v1.pdf








DSRIPIncentiveImpactProjectTitle:Project3‐IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)

ProjectCode:3.9

PaymentMethod:P4P


ProjectCode:5.9

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

DiabetesMellitus:DailyAspirinorAnti‐plateletMedicationUseforPatientswithDiabetesandIschemicVascularDisease

DSRIP#:100

MeasureDescription:Percentageofpatients18to75yearsofagewithdiabetesmellitusandischemicvasculardiseasewithdocumenteddailyaspirinoranti‐plateletmedicationuseduringthemeasurementyearunlesscontraindicated.DataSource:

Chart/EHRNQF#:

0729

MeasureSteward:MinnesotaCommunityMeasurement(MNCM)


MeasureCalculationDescriptionNumerator:Patientswithadiagnosisofdiabetesandischemicvasculardiseasewithdocumentationoftakingdailyaspirinoranti‐plateletmedicationorhaveadocumentedcontraindicationinthemeasurementyear.AcceptedContraindications:

1. Prescribedanticoagulantuse,Lovenox(enoxaparin)orCoumadin(warfarin)2. Historyofgastrointestinal(GI)*3. Historyofintracranialbleeding4. Bleedingdisorder5. Otherdocumentedreason:allergytoaspirin(ASA)oranti‐platelets6. Otherdocumentedreason:useofnon‐sterodialanti‐inflammatorymeasures7. Otherdocumentedreason:documentedriskfordruginteraction8. Otherdocumentedreason:uncontrolledhypertension(systolicbloodpressuregreaterthan

180mm/Hgand/ordiastolicbloodpressuregreaterthan110mmHg)9. Otherdocumentedreason:gastroesophagealrefluxdisease(GERD)

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patients18to75yearsofagewithadiagnosisofdiabetesmellituswithtwoormoreface‐to‐facevisitsfordiabetesinthelasttwoyearsandatleastonevisitforanyreasoninthelast12monthsandadiagnosisofischemicvasculardisease.Acompletelistofdiagnosiscodesidentifyingdiabetesmellitusandischemicvasculardisease(IVD)canbefoundinAppendixA‐59andAppendixA‐60.Exclusions:

1. Patientwasapermanentnursinghomeresidentatanytimeduringthemeasurementperiod2. Patientwasinhospiceorreceivingpalliativecareatanytimeduringthemeasurement

period3. Patientdiedpriortotheendofthemeasurementperiod4. Patientwaspregnantatanytimeduringthemeasurementperiod5. Documentationthatdiagnosiswascodedinerror




MeasureQualifications:DataElements:

DateofBirth DiagnosisCode(s) ProcedureCode(s) DailyAspirinorderinstructions PatientStatus

Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances:

http://www.cms.gov/Medicare/Medicare‐Fee‐for‐Service‐Payment/sharedsavingsprogram/Downloads/ACO‐NarrativeMeasures‐Specs.pdfhttp://www.health.state.mn.us/healthreform/measurement/msr812prp01odc.pdf









ProjectTitle:Project11–ImproveOverallQualityofCareforPatientsDiagnosedwithDiabetesMellitusandHypertension


PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

ElectiveDelivery

DSRIP#:37

MeasureDescription:Thismeasureassessespatientswithelectivevaginaldeliveriesorelectivecesareansectionsat>=37and<39weeksofgestationcompleted. DataSource:

Chart/EHRNQF#:

0469


MeasureStewardVersion:V2017B1

MeasureCalculationDescriptionNumerator:Patientswithelectivedeliveries.

1. Medicalinductionoflabor(Table37.1)whilenotinLaborpriortotheprocedure.

Table37.1:CodestoIdentifyMedicalInductionofLabor(AppendixA‐52)CodeType CodesICD‐9‐PCS 73.01,73.1,73.4

ICD‐10‐PCS0U7C7DZ,0U7C7ZZ,10900ZC,10903ZC,10904ZC,10907ZC,

10908ZC,3E033VJ

Table37.2:CodestoIdentifyCesareanSection(AppendixA‐47)CodeType CodesICD‐9‐PCS 74.0,74.1,74.2,74.4,74.99ICD‐10‐PCS 10D00Z0,10D00Z1,10D00Z2

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thosepatientsages8through64yearsofagedeliveringnewbornswith>=37and<39weeksofgestationcompleted.(Table37.3)orAppendixA‐22.

Table37.3:CodestoIdentifyPlannedCesareanSectioninLabor(AppendixA‐53)CodeType CodesICD‐9‐CM 649.81,649.82ICD‐10‐CM O7582



Exclusion(s):

1. ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCodeorICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCodesforconditionspossiblyjustifyingelectivedeliverypriorto39weeksgestation(SeeAppendixA‐10).

2. Patientslessthan8yearsofage.3. Patientsgreaterthanorequalto65yearsofage.4. Patientswithalengthofstay>120days.5. Patientsenrolledinclinicaltrials.6. Patientswithprioruterinesurgery.7. GestationalAge<37or>=39weeksorUnabletoDetermine(UTD)(AppendixA‐10)

Result:Theresultisexpressedasapercentage.Improvementdirection:Lower


DataElements:

Numerator

ICD‐9‐PCS/ICD‐10‐PCSOtherProcedureCodes ICD‐9‐PCS/ICD‐10‐PCSPrincipalProcedureCode Labor PriorUterineSurgery

Denominator AdmissionDate Birthdate ClinicalTrial DischargeDate GestationalAge ICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCodes ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCode PriorUterineSurgery

Thismeasureisapartofasetoffivenationallyimplementedmeasuresthataddressperinatalcare(PC‐02:CesareanSection,PC‐03:AntenatalSteroids,PC‐04:HealthCare‐AssociatedBloodstreamInfectionsinNewborns,PC‐05:ExclusiveBreastMilkFeeding).

Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances:

https://manual.jointcommission.org/releases/TJC2015B1/











ProjectCode:NA

PaymentMethod:NA


UniversalCode:41

PaymentMethod:UPP



Measure:

EmergencyMedicine:Community‐AcquiredPneumonia(CAP):AssessmentofMentalStatus

DSRIP#:69

MeasureDescription:Thismeasureisusedtoassessthepercentageofpatientsaged18yearsandolderwithadiagnosisofcommunity‐acquiredpneumoniawithmentalstatusassessed.DataSource:

Chart/EHRNQF#:

NotFound

MeasureSteward:AMA‐PCPI


MeasureCalculationDescriptionNumerator:Allpatientsforwhommentalstatuswasassessed.Assessed:Mayinclude:Documentationbyclinicianthatpatient’smentalstatuswasnoted(e.g.,patientisorientedordisoriented).(AppendixA‐99)

Denominator:OftheNewJerseyLowIncomeattributedpopulation,allpatientsagedgreaterthanorequalto18yearswithcommunity‐acquiredbacterialpneumonia.PatientsqualifyfordenominatorusingeitherOption1or2below.Option1:Diagnosiscodes(AppendixA‐100)ANDServicecodes(AppendixA‐101)Option2:Diagnosiscodes(AppendixA‐100)ANDServicecodes(AppendixA‐102)ANDPlaceofservice(AppendixA‐103)






http://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/PQRS/2012_Physician_Quality_Reporting_System.html









DSRIPIncentiveImpactProjectTitle:Project17–PatientsReceiveRecommendedCareforCommunity‐AcquiredPneumonia

ProjectCode:17.2


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

EyeExamination

DSRIP#:39

MeasureDescription:Thepercentageofpatients18‐75yearsofagewithdiabetes(type1ortype2)whohadaretinaleyeexamperformed.DataSource:

Chart/EHRNQF#:

0055

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhoreceivedaretinaleyeexam.(AppendixA‐63)Includes:

1. Aretinalordilatedeyeexambyaneyecareprofessional(optometristorophthalmologist)inthemeasurementyear.

2. Anegativeretinalordilatedeyeexam(negativeforretinopathy)byaneyecareprofessionalintheyearpriortothemeasurementyear.

Oranyofthefollowingcriteria:1. Aretinalscreeningcode(AppendixA‐63)billedbyaneyecareprofessional

(optometristorophthalmologist)duringthemeasurementyear.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientswhoare18‐75yearsofageasofDecember31ofthemeasurementyearwhohadadiagnosisofdiabetes(type1ortype2).(AppendixA‐28)Patientswithdiabetesmellitusareidentifiedusingdiagnosiscodesand/orpharmacydatawithintheinpatientoroutpatientclaimsdata.Onlyonemethodtoidentifypatientsisneededtobeincludedinthedenominator.




4. Pharmacydata.Patientswhoweredispensedinsulinorhypoglycemic/antihyperglycemicson

anambulatorybasisduringthemeasurementyearortheyearpriortothemeasurementyear.(AppendixA‐9)



PrescriptionstoIdentifyMemberswithDiabetes


Acarbose Miglitol














Empagliflozin‐linagliptin(Glyxambi)

Empagliflozin‐metformin(Synjardy)


Insulindetemir Insulinglargine Insulinglulisine

Insulinisophanehuman Insulinisophane‐insulinregular Insulinlispro Insulinlispro‐insulinlisproprotamine Insulinregularhuman Insulinhumaninhaled(Afrezza)


Exenatide Dulaglutide(Trulicity)

Liraglutide Albiglutide




Glipizide Glyburide






Note:Glucophage/metforminasasoloagentisnotincludedbecauseitisusedtotreatconditionsotherthandiabetes;memberswithdiabetesonthesemedicationsareidentifiedthroughdiagnosiscodesonly.NCQAwillpostacompletelistofmedicationsandNDCcodestowww.ncqa.orgbyNovember2,2015.Exclusion(s):







http://www.qualityforum.org/QPS/0055http://www.ncqa.org/HEDISQualityMeasurement.aspx








DSRIPIncentiveImpactProjectTitle:Project11–ImproveOverallQualityofCareforPatientsDiagnosedwithDiabetesMellitusandHypertension

ProjectCode:11.3


ProjectTitle:Project12–DiabetesGroupVisitsforPatientsandCommunityEducation

Project Code:12.3


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

FootExamination

DSRIP#:43

MeasureDescription:Percentageofpatientswhoreceivedatleastonecompletefootexam(visualinspection,sensoryexamwithmonofilament,andpulseexam).DataSource:

Chart/EHRNQF#:

NotFound

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhoreceivedatleastonecompletefootexam(visualinspection,sensoryexamwithmonofilament,andpulseexam).

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientswhoare18‐75yearsofageasofDecember31ofthemeasurementyearwhohadadiagnosisofdiabetes(type1ortype2).Exclusion(s):1. Patientswithbilateralfootamputation.




ThismeasureisnolongerincludedintheAMADiabetesSet.








ContinuousEligibility/RiskAdjustment/SamplingMethodology


DSRIPIncentiveImpactProjectTitle:Project11‐ImproveOverallQualityofCareforPatientsDiagnosedwithDiabetesMellitusandHypertension

ProjectCode:11.2



ProjectCode:12.2


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

HeartFailure:Angiotensin‐ConvertingEnzyme(ACE)InhibitororAngiotensinReceptorBlocker(ARB)TherapyforLeftVentricularSystolicDysfunction(inpatientsetting)

DSRIP#:9

MeasureDescription:Percentageofpatientsaged18yearsandolderwithadiagnosisofheartfailurewithacurrentorpriorLVEF<40%whowereprescribedACEinhibitororARBtherapyeitherwithina12monthperiodwhenseenathospitaldischarge.DataSource:

Chart/EHRNQF#:

0081


MeasureStewardVersion:12/2017V2.0

MeasureCalculationDescriptionNumerator:PatientswhowereprescribedanAngiotensin‐ConvertingEnzyme(ACE)inhibitororAngiotensinReceptorBlocker(ARB)therapyathospitaldischarge.Prescribed‐Inpatientsetting–aprescriptiongiventothepatientforACEinhibitororARBtherapyatdischarge.

Medicationmustbepresentonthedischargemedicationlist.Thefollowinglistofmedications/drugnamesisbasedonclinicalguidelinesandotherevidenceandmaynotbeall‐inclusiveorcurrent.PhysiciansandotherhealthcareprofessionalsshouldrefertotheFDA’swebsitepageentitled“DrugSafetyCommunications”forup‐to‐datedrugrecallandalertinformationwhenprescribingmedications.ACEInhibitorMedications

Captopril Enalapril Fosinopril Lisinopril Perindopril Quinapril Ramipril Trandolapril

AngiotensinReceptorBlockers

Candesartan Losartan Valsartan



Denominator:OftheNewJerseyLowIncomeattributedpopulation,allpatientsaged18yearsandolderwithaprincipaldiagnosisofheartfailurewithacurrentorpriorLeftVentricular(LVEF)<40%.LVEF<40%‐correspondstoqualitativedocumentationofmoderatedysfunctionorseveredysfunction.Table9.1:CodestoIdentifyHeartFailure(AppendixA‐30)

CodeType

Code

CPT 99201‐99203,99204,99205,99212‐9921599241‐99245,99304‐99310,99324‐99328,99334‐99337,99341‐99345,99347‐99350

ICD‐9 402.01,402.11,402.91,404.01,404.03,404.11,404.13,404.91,404.93,428.0,428.1,428.20‐428.23,428.30‐428.33,428.40‐

428.43,428.9

ICD‐10 I11.0,l13.0,l13.2,I50.20‐23,I50.30‐33,I50.40‐43,I50.9,l50.1I50.810,I50.811,I50.812,I50.813,I50.841,I50.82,I50.83,I50.84,

Exclusion(s):

1. Patientswhoexpired.2. Patientswholeftagainstmedicaladvice(AMA).3. Patientsdischargedtohospice.



Thismeasurefollowstheinpatientcriteriasetoutbythemeasuresteward.


http://www.ama‐assn.org/apps/listserv/x‐check/qmeasure.cgi?submit=PCPIhttps://www.ncdr.com/WebNCDR/docs/default‐source/pinnacle‐public‐documents/2018_measure_005_registry.pdf?sfvrsn=8





SettingofCare:InpatientorEmergencyDepartment








ProjectCode:6.1



ProjectCode:7.2



ProjectCode:8.2


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

HospitalAcquiredPotentiallyPreventableVenousThromboembolism

DSRIP#:47

MeasureDescription:ThenumberofpatientsdiagnosedwithconfirmedVTEduringhospitalization(notpresentatadmission)whodidnotreceiveVTEprophylaxisbetweenhospitaladmissionandthedaybeforetheVTEdiagnostictestingorderdate.(VTE‐6)DataSource:

Chart/EHRNQF#:

NotFound


MeasureStewardVersion:2018a.2_v5_2b

MeasureCalculationDescriptionNumerator:Patientswhoreceivednovenousthromboembolism(VTE)prophylaxispriortotheVTEdiagnosistestorderdate.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientsage18yearsandolderwhodevelopedconfirmedVTEduringhospitalization.DenominatorInclusionCriteria:DischargeswithanICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCodesofVTEasdefinedinAppendixA‐20orAppendixA‐54.Exclusion(s):

1. Patientslessthan18yearsofage2. Patientswhohaveahospitallengthofstay(LOS)greaterthan120days3. PatientswithComfortMeasuresOnlydocumented.4. Patientsenrolledinclinicaltrials5. PatientswithanICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCodesofVTEasdefinedinAppendix

A‐20orAppendixA‐54.6. PatientswithVTEPresentatAdmission7. Patientswithreasonsfornotadministeringmechanicalandpharmacologicprophylaxis8. PatientswithoutVTEconfirmedbydiagnostictesting

Result:Theresultisexpressedasapercentage.ImprovementDirection:Lower





1. VTEProphylaxisStatusDenominator:

1. AdmissionDate2. Birthdate3. ClinicalTrial4. ComfortMeasuresOnly5. DischargeDate6. ICD–10orICD‐9DiagnosisCodes7. ICD‐10orICD‐9DiagnosisCode8. VTEConfirmed9. VTEDiagnosticTest10. VTEPresentatAdmission11. ReasonforNoAdministrationofVTEProphylaxis


http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx







SamplingorRiskAdjustmentMethodologyForhospitalsselectingsamplecasesforstratifiedmeasuresetsormeasuresetswithsub‐populations(CACandVTE),amodifiedsamplingprocedureisrequired.Hospitalsselectingsamplecasesforthesesetsmustensurethateachindividualstratum’spopulation/sub‐populationandsamplesizemeetstheconditionsstatedinthemeasureset’sSampleSizeRequirements.(SeeVTEandCACsamplerequirementsfromtheJointCommission.Oncetheelectronicmanualisopen,thesamplingtablesandmethodologycanbefoundonthefollowingdocument:“2zg.VTE_List.pdf”)

Quarterlydatawillberequiredtobereportedsemi‐annually.EachquarterdatawillbeaggregatedbythehospitalintheStandardizedReportingWorkbookforasemi‐annualreportedrate.


ProjectCode:NA

PaymentMethod:NA


UniversalCode:30

PaymentMethod:UPP



Measure:

InitialAntibioticSelectionforCommunity‐AcquiredPneumonia(CAP)inImmunocompetentPatient

DSRIP#:51

MeasureDescription:Thismeasureisusedtoassesspneumoniapatientswhoreceivedaninitialantibioticregimenconsistentwithcurrentguidelinesduringthefirst24hoursoftheirhospitalization.DataSource:

Chart/EHRNQF#:

0147



MeasureCalculationDescriptionNumerator:Pneumoniapatientswhoreceivedaninitialantibioticregimenconsistentwithcurrentguidelinesduringthefirst24hoursoftheirhospitalization.Antibioticguidelinesbypatienttype:Non–ICUPatientAntipneumococcalQuinolonemonotherapy(IVorPO)AppendixA‐90–Regimen1aOrTigecyclinemonotherapy(IV)AppendixA‐86–Regimen2aOrβ‐lactam(IVorIM)Table2.3+Macrolide(IVorPO)AppendixA‐80–Regimen3aOrβ‐lactam(IVorIM)Table2.3+Doxycycline(IVorPO)Table2.10–Regimen3aNon‐ICUpatientwithPseudomonalRiskTheseregimensareacceptableforNon‐ICUpatientswithPseudomonalRiskONLY:Antipneumococcal/Antipseudomonalβ‐lactam(IV)AppendixA‐79+AntipseudomonalQuinolone(IVorPO)AppendixA‐83–Regimen4aOrAntipneumococcal/Antipseudomonalβ‐lactam(IV)AppendixA‐79+Aminoglycoside(IV)AppendixA‐85+eitherAntipneumococcalQuinolone(IVorPO)AppendixA‐90OrMacrolide(IVorPO)AppendixA‐80–Regimen5a



Non‐ICUpatientswithβ‐lactamallergyandPseudomonalRiskONLYTheseregimensareacceptableforNon‐ICUpatientswithβ‐lactamallergyandPseudomonalRiskONLY:Aztreonam(IVorIM)AppendixA‐82+AntipneumococcalQuinolone(IVorPO)AppendixA‐90+Aminoglycoside(IV)AppendixA‐85–Regimen6aOrAztreonam2(IVorIM)AppendixA‐82+Levofloxacin1(IVorPO)AppendixA‐89–Regimen7a1Levofloxacinshouldbeusedin750mgdosagewhenusedinthemanagementofpatientswithpneumonia.2Forpatientswithrenalinsufficiency.ICUPatientMacrolide(IV)AppendixA‐81+eitherβ‐lactam(IV)AppendixA‐88ORAntipneumococcal/Antipseudomonalβ‐lactam(IV)AppendixA‐79–Regimen1bOrAntipseudomonalQuinolone(IV)AppendixA‐83+eitherβ‐lactam(IV)AppendixA‐88ORAntipneumococcal/Antipseudomonalβ‐lactam(IV)AppendixA‐79–Regimen2bOrAntipneumococcalQuinolone(IV)AppendixA‐87+eitherβ‐lactam(IV)AppendixA‐88ORAntipneumococcal/Antipseudomonalβ‐lactam(IV)AppendixA‐79–Regimen2bOrAntipneumococcal/Antipseudomonalβ‐lactam(IV)AppendixA‐79+Aminoglycoside(IV)AppendixA‐85+eitherAntipneumococcalQuinolone(IV)AppendixA‐87ORMacrolide(IV)AppendixA‐81–Regimen3bICUPatientwithFrancisellatularensisorYersiniapestisriskIfthepatienthasFrancisellatularensisorYersiniapestisriskasdeterminedbyAnotherSourceofInfection(seedataelement)thefollowingisanotheracceptableregimen:Doxycycline(IV)AppendixA‐84+eitherB‐lactam(IV)AppendixA‐88ORAntipneumococcal/Antipseudomonalβ‐lactam(IV)AppendixA‐79–Regimen4b

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thoseICUpneumoniapatients18yearsofageandolderwithaprincipaldiagnosisofpneumonia(AppendixA‐69),oraprincipaldiagnosiscodeofsepticemia(AppendixA‐70),orrespiratoryfailure(acuteorchronic)(AppendixA‐71)withanICD‐10‐CMOtherDiagnosisCodeofpneumonia(AppendixA‐69).



Exclusion(s):1. Patientslessthan18yearsofage.2. Patientswhohavealengthofstaygreaterthan120days.3. PatientswithCysticFibrosis.(AppendixA‐72)

4. Patientswhohadnochestx‐rayorCTscanthatindicatedabnormalfindingswithin24hours

priortohospitalarrivaloranytimeduringthishospitalization.5. PatientswithComfortMeasuresOnlydocumenteddayofordayafterarrival.6. Patientsenrolledinclinicaltrials.7. Patientsreceivedasatransferfromtheemergency/observationdepartmentofanother

hospital.8. Patientsreceivedasatransferfromaninpatientoroutpatientdepartmentofanother

hospital.9. Patientsreceivedasatransferfromanambulatorysurgerycenter.10. PatientswhohavenodiagnosisofpneumoniaeitherastheEDfinaldiagnosis/impressionor

directadmissiondiagnosis/impression.11. Patientstransferred/admittedtotheICUwithin24hoursafterarrivaltothishospital,witha

beta‐lactamallergy.12. Patientswhohavedurationofstaylessthanorequaltooneday.13. PneumoniapatientswithAnotherSourceofInfectionwhodidnotreceiveanantibiotic

regimenrecommendedforpneumonia,butdidreceiveantibioticswithinthefirst24hoursofhospitalization.

14. PatientswithareasonforAlternativeEmpiricAntiobioticTherapy



ThismeasureisbasedontheJointCommissionPneumoniaset,i.e.PN‐6.


AntibioticAdministrationDate AntibioticAdministrationRoute AntibioticAdministrationTime AntibioticAllergy AntibioticName ArrivalDate ArrivalTime PseudomonasRisk

Denominator: AdmissionDate



•AnotherSourceofInfection•AntibioticAdministrationDate•AntibioticAdministrationTime•AntibioticName•AntibioticReceived•Birthdate•ChestX‐Ray•ClinicalTrial•ComfortMeasuresOnly•DischargeDate•ICD‐9‐CMOtherDiagnosisCodes•ICD‐9‐CMPrincipalDiagnosisCode•ICUAdmissionorTransfer•PneumoniaDiagnosis:ED/DirectAdmit•PseudomonasRisk•ReasonforAlternativeEmpiricAntibioticTherapy•TransferFromAnotherHospitalorASC

Retrospective,datasourcesforrequireddataelementsincludeadministrativedataandmedicalrecorddocuments.Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances:

http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatientquality_measures.aspxhttps://manual.jointcommission.org/releases/archive/TJC2010B/MIF0013.html








DSRIPIncentiveImpactProjectTitle:Project17–PatientsReceiveRecommendedCareforCommunity‐AcquiredPneumonia

ProjectCode:17.5

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

IschemicVascularDisease(IVD):CompleteLipidProfileandLDL‐CControl<100mg/dL

DSRIP#:55

MeasureDescription:

Thepercentageofmembers18to75yearsofagewhoweredischargedaliveforAMI,coronaryarterybypassgraft(CABG)orpercutaneouscoronaryinterventions(PCI)intheyearpriortothemeasurementyear,orwhohadadiagnosisofischemicvasculardisease(IVD)duringthemeasurementyearandtheyearpriortothemeasurementyear,whohadLDL‐Ccontrol(<100mg/dL)duringthemeasurementyear.DataSource:

Chart/EHRNQF#(nolongerendorsed):

Basedon0075

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:PatientswhosemostrecentLDL‐Cscreening(Table55.1),performedduringthemeasurementyear,islessthan100mg/dL

Table55.1:CodestoIdentifyLDL‐CScreening(AppendixA‐51)CPT CPTCategoryII LOINC

80061,83700,83701,83704,83721

3048F,3049F,3050F

2089‐1,12773‐8,13457‐7,18261‐8,18262‐6,22748‐8,39469‐2,49132‐4,55440‐2,69419‐0

Table55.2:CodestoIdentifyLDL‐CLevels

Description CPTCategoryII

LDL‐C<100mg/dL 3048F

LDL‐C≥100mg/dL 3049F,3050F

Exclusion(s):

1. TheresultofthemostrecentLDL‐Cscreeningis≥100mg/dL.2. TheresultofthemostrecentLDL‐Cscreeningismissing.3. AnLDL‐Cscreeningwasnotperformed.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientswhoare18to75yearsofagedischargedaliveforAMI(AppendixA‐64),CABG(AppendixA‐65)orPCI(AppendixA‐66)duringthe12monthspriortothemeasurementyearorwhohadatleastoneoutpatientvisitoracuteinpatientencounterwithadiagnosisofIVD(AppendixA‐67)duringboththemeasurementyearandtheyearpriortothemeasurementyear(criteriadonotneedtobesameforbothyears).




ImprovementDirection:Higher


DateofBirth DiagnosisCode(s) ProcedureCode(s) DatewhenLDLtestwasperformed ResultsofLDLtest

LDL‐Clevelsmaybecalculatedfromtotalcholesterol,HDL‐CandtriglyceridesusingtheFriedewaldequationifthetriglyceridesare≤400mg/dL.

(LDL‐C)=(totalcholesterol)–(HDL)–(triglycerides/5) Iflipoprotein(a)ismeasured,usethefollowingcalculation.

(LDL‐C)=(totalcholesterol)–(HDL)–(triglycerides/5)–0.3[lipoprotein(a)]

Theseformulaeareusedwhenalllevelsareexpressedinmg/dLandcannotbeusediftriglycerides>400mg/dL.TheFriedewaldequationmaynotbeusedifadirectorcalculatedresultispresentinthemedicalrecordforthemostrecentLDL‐Ctest.Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances.

http://www.ncqa.org/HEDISQualityMeasurement.aspx








DSRIPIncentiveImpactProjectTitle:Project6–CareTransitionsInterventionModeltoReduce30‐DayReadmissionsforChronicCareConditions


PaymentMethod:P4P

ProjectTitle:Project7–ExtensivePatientCHF‐FocusedMulti‐TherapeuticModel


PaymentMethod:P4P

ProjectTitle:Project8–TheCongestiveHeartFailureTransitionProgram(CHF‐TP)


PaymentMethod:P4P


UniversalCode:18




Measure:

LeftVentricularEjectionFraction(LVEF)Assessment

DSRIP#:57

MeasureDescription:Percentageofpatientsaged18yearsandolderwithadiagnosisofheartfailureforwhomthequantitativeorqualitativeresultsofarecentorprior(anytimeinthepast)LVEFassessmentisdocumentedwithina12monthperiod.DataSource:

Chart/EHRNQF#:

0079


MeasureStewardVersion:July17

MeasureCalculationDescriptionNumerator:Patientsforwhomthequantitativeorqualitative**resultsofarecentorprior(anytimeinthepast)LVEFassessmentisdocumentedwithina12monthperiod.(AppendixA‐30)Documentation‐mustincludedocumentationinaprogressnoteoftheresultsofanLVEFassessment,regardlessofwhentheevaluationofejectionfractionwasperformed.**Qualitativeresultscorrespondtonumericequivalentsasfollows:

Hyperdynamic:correspondstoLVEFgreaterthan70% Normal:correspondstoLVEF50%to70%(midpoint60%) Milddysfunction:correspondstoLVEF40%to49%(midpoint45%) Moderatedysfunction:correspondstoLVEF30%to39%(midpoint35%) Severedysfunction:correspondstoLVEFlessthan30%

NumeratorInclusionCriteria:Patientsforwhomthequantitativeorqualitativeresultsofarecentorprior(anytimeinthepast)LVEFassessmentisdocumentedwithina12monthperiod.CPTCategoryIICode

3021F‐Leftventricularejectionfraction(LVEF)lessthan40%ordocumentationofmoderatelyorseverelydepressedleftventricularsystolicfunction

3022F‐Leftventricularejectionfraction(LVEF)greaterthanorequalto40%ordocumentationasnormalormildlydepressedleftventricularsystolicfunction

Denominator:OftheNewJerseyLowIncomeattributedpopulation,allpatientsaged18yearsandolderwithadiagnosisofheartfailure.(AppendixA–30)






ThismeasureisnolongerincludedintheAMAMeasureSet

http://www.ama‐assn.org/apps/listserv/x‐check/qmeasure.cgi?submit=PCPI








DSRIPIncentiveImpactProjectTitle:Project7‐ExtensivePatientCHF‐FocusedMulti‐TherapeuticModel

ProjectCode:7.1


ProjectTitle:Project8‐TheCongestiveHeartFailureTransitionProgram(CHF‐TP)

ProjectCode:8.1


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

LipidManagement

DSRIP#:58

MeasureDescription:Thepercentageofpatients18‐75withdiabetes(type1ortype2)whohadatleastonelipidprofile(orallcomponenttests).DataSource:

Chart/EHRNQF#:

NotFound

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhoreceivedatleastonelipidprofile(orALLcomponenttests).Table58.1:CPTCategoryIcodes

Code Description80061 LipidPanel82465* Cholesterol,serum,total83718* Lipoprotein,directmeasurement,highdensity

cholesterol(HDL)84478* Triglycerides83721 Lipoprotein,directmeasurement,lowdensity

cholesterol(LDL)*Mustbeincludedtobillpanelcode80061.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientsaged18‐75diagnosedwithdiabetes(type1ortype2).



DateofBirth DiagnosisCode(s) ProcedureCode(s)

Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances.

http://www.ama‐assn.org/ama1/pub/upload/mm/pcpi/diabetesset.pdfThismeasureisnolongerincludedintheAMADiabetesSet.







CY2014CY2016ImprovementTargetGoal(ITG):

NAAbsoluteITGValue:

NAAttributionDate:

LastdayofmeasurementperiodAnchorDate:

NA




DSRIPIncentiveImpactProjectTitle:Project11:ImproveOverallQualityofCareforPatientswithDiabetesMellitisandHypertension

ProjectCode:11.1


ProjectTitle:Project12:DiabetesGroupVisitsforPatientsandCommunityEducation

ProjectCode:12.1


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

MajorDepressiveDisorder(MDD):SuicideRiskAssessment

DSRIP#:59

MeasureDescription:Percentageofpatientsaged18yearsandolderwithanewdiagnosisorrecurrentepisodeofmajordepressivedisorder(MDD)whohadasuicideriskassessmentcompletedduringthevisitinwhichanewdiagnosisorrecurrentepisodewasidentified.DataSource:

Chart/EHRNQF#:

0104



MeasureCalculationDescriptionNumerator:Patientswithasuicideriskassessmentcompletedduringthevisitinwhichanewdiagnosisorrecurrentepisodewasidentified.Suicideriskassessmentmustincludequestionsaboutthefollowing:

1. Suicidalideation2. Patient’sintentofinitiatingasuicideattemptAND,ifeitherispresent,

a. Patientplansforasuicideattemptb. Whetherthepatienthasmeansforcompletingsuicide

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientsaged18yearsandolderwithanewdiagnosisorrecurrentepisodeofmajordepressivedisorder(MDD).(Tables59.1and59.2)Table59.1:CodestoIdentifyMajorDepressiveDisorder–SingleEpisode(AppendixA‐61)

CodeType CodesICD‐9‐CM 296.20,296.21,296.22,296.23,296.24ICD‐10‐CM F32.0,F32.1,F32.2,F32.3,F32.9,F33.0,F33.1

Table59.2:CodestoIdentifyMajorDepressiveDisorder–Recurrent(AppendixA‐62)

CodeType CodesICD‐9‐CM 296.30,296.31,296.32,296.33,296.34ICD‐10‐CM F33.2,F33.3,F33.9





DateofBirth DateofMDDdiagnosis,ifrecurrent SuicideAssessmentDate ICD‐9‐CM/ICD‐10‐CMDiagnosiscodes


ThismeasureisnolongerincludedintheAMAMeasureSet http://www.ama‐assn.org/ama1/pub/upload/mm/pcpi/major‐depressive‐disorder‐adult‐worksheets.pdf









DSRIPIncentiveImpactProjectTitle:Project3–IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)

ProjectCode:3.4


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Medicalattentionfornephropathy

DSRIP#:

98MeasureDescription:Thepercentageofpatients18‐75yearsofagewithdiabetes(type1andtype2)whoreceivedanephropathyscreeningtestorhadevidenceofnephropathyduringthemeasurementyear.DataSource:

Chart/EHRNQF#:

0062

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswithanephropathyscreeningduringthemeasurementyearorevidenceofnephropathyduringthemeasurementyear.NumeratorInclusionCriteria:

Evidenceofnephropathyincludesanyofthefollowing:

1. Anencounterwithacodetoindicateevidenceofnephropathyscreening()ornephropathyasindicatedbythefollowing()duringthemeasurementyear.

Anephropathyscreeningormonitoringtest(AppendixA‐104).

EvidenceoftreatmentfornephropathyorACE/ARBtherapy(AppendixA‐105).

Evidenceofstage4chronickidneydisease(AppendixA‐106).

EvidenceofESRD(AppendixA‐107).

Evidenceofkidneytransplant(AppendixA‐108).

AtleastoneACEinhibitororARBdispensingevent(AppendixA‐1).

2. Documentationthataurinemicroalbumintestwasperformed.Documentationmustincludeanoteindicatingthedatewhenaurinemicroalbumintestwasperformed,andtheresult.Anyofthefollowingmeetthecriteriaforaurinemicroalbumintest:

24‐hoururineformicroalbumin

Timedurineformicroalbumin

Spoturineformicroalbumin

Urineformicroalbumin/creatinineratio

24‐hoururinefortotalprotein

Randomurineforprotein/creatinineratio

3. Anephrologistvisitduringthemeasurementyear(norestrictiononthediagnosisorprocedurecodesubmitted).

4. Documentationofarenaltransplant.

5. Documentationofmedicalattentionforanyofthefollowing(norestrictiononprovidertype):



Diabeticnephropathy ESRD Chronicrenalfailure(CRF) Chronickidneydisease(CKD) Renalinsufficiency Proteinuria Albuminuria Renaldysfunction Acuterenalfailure(ARF) Dialysis,hemodialysisorperitonealdialysis

6. EvidenceofACEinhibitor/ARBtherapyduringthemeasurementyear.Patientswhohadan

encounterwithacodeindicatingtherapy(Table98.3)orreceivedanambulatoryprescriptionorweredispensedanambulatoryprescriptionforACEinhibitorsorARBsduringthemeasurementyear.AcomprehensivemedicationlistcanbefoundinAppendixA‐1.

Table98.3:ACEInhibitors/ARBs(AppendixA‐1)

Description PrescriptionAngiotensinconvertingenzymeinhibitors

BenazeprilCaptopril

EnalaprilFosinopril

LisinoprilMoexipril

PerindoprilQuinapril

RamiprilTrandolapril

AngiotensinIIinhibitors AzilsartanCandesartan

EprosartanIrbesartan

LosartanOlmesartan

TelmisartanValsartan

Antihypertensivecombinations

Aliskiren‐valsartanAmlodipine‐benazeprilAmlodipine‐hydrochlorothiazide‐valsartanAmlodipine‐hydrochlorothiazide‐olmesartanAmlodipine‐olmesartanAmlodipine‐telmisartanAmlodipine‐valsartan

Azilsartan‐chlorthalidoneBenazepril‐hydrochlorothiazideCandesartan‐hydrochlorothiazideCaptopril‐hydrochlorothiazideEnalapril‐hydrochlorothiazideEprosartan‐hydrochlorothiazideFosinopril‐hydrochlorothiazideHydrochlorothiazide‐irbesartanHydrochlorothiazide‐lisinopril

Hydrochlorothiazide‐losartanHydrochlorothiazide‐moexiprilHydrochlorothiazide‐olmesartanHydrochlorothiazide‐quinaprilHydrochlorothiazide‐telmisartanHydrochlorothiazide‐valsartanTrandolapril‐verapamil

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patients18to75yearsofagewithdiabetes(type1andtype2).(AppendixA‐28)Patientswithdiabetesmellitusareidentifiedusingdiagnosiscodesand/orpharmacydatawithintheinpatientoroutpatientclaimsdata.Onlyonemethodtoidentifypatientsisneededtobeincludedinthedenominator.






2. Pharmacydata.Patientswhoweredispensedinsulinorhypoglycemic/antihyperglycemicsonan

ambulatorybasisduringthemeasurementyearortheyearpriortothemeasurementyear.(AppendixA‐9)

PrescriptionstoIdentifyMembersWithDiabetes(AppendixA‐9)


Acarbose Miglitol





Dapagliflozin‐metformin

Empaglifozin‐linagliptin

Empagliflozin‐metformin











Insulindegludec Insulindetemir Insulinglargine Insulinglulisine

Insulinisophanehuman Insulinisophane‐insulinregular Insulinlispro Insulinlispro‐insulinlisproprotamine Insulinregularhuman


Exenatide Dulaglutide

Liraglutide Albiglutide




Glipizide Glyburide








Note:Glucophage/metforminasasoloagentisnotincludedbecauseitisusedtotreatconditionsotherthandiabetes;memberswithdiabetesonthesemedicationsareidentifiedthroughdiagnosiscodesonly.NCQAwillpostacompletelistofmedicationsandNDCcodestowww.ncqa.orgbyNovember2,2017

Exclusion(s):



MeasureQualifications:Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualifications/definitionsanddatacollection.Thisisprovidedwithoutassurances:









DSRIPIncentiveImpactProjectTitle:Project11–ImproveOverallQualityofCareforPatientsDiagnosedwithDiabetesMellitusandHypertension


PaymentMethod:P4P



PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

MedicationReconciliation

DSRIP#:61

MeasureDescription:Percentageofpatientsaged18yearsandolderdischargedfromanyinpatientfacility(i.e.hospital)andseenwithin31daysofdischargeintheofficebythephysician,prescribingpractitioner,registerednurse,orclinicalpharmacistwhohadreconciliationofthedischargemedicationswiththecurrentmedicationlistintheoutpatientrecorddocumented.DataSource:

Chart/EHRNQF#:

Basedon0097

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhohadareconciliationofthedischargemedicationswiththecurrentmedicationlistintheoutpatientmedicalrecorddocumented.

Table61.1:CodestoIdentifyMedicationReconciliationDescription CPTCodes

Medicationreconciliation 1111F,99495,99496

Denominator:OftheNewJerseyLowIncomeattributedpopulation,allpatientsaged18yearsandolderdischargedfromanyinpatientfacility(i.e.hospital)betweenJanuary1andDecember1ofthemeasurementyearandseenwithin31daysofdischargeintheofficebythephysician,prescribingpractitioner,registerednurse,orclinicalpharmacistprovidingon‐goingcare.Thedenominatorforthismeasureisbasedondischarges,notpatients.Ifapatienthasmorethanonedischarge,includealldischargesonorbetweenJanuary1andDecember1ofthemeasurementyear.(AppendixA‐33)Ifthedischargeisfollowedbyareadmissionordirecttransfertoanacutefacilitywithinthe30‐dayfollow‐upperiod,onlycountthereadmissiondischargeorthedischargefromwhichthepatientwastransferred.Thismeasureisreportedastworatesstratifiedbyagegroup:

1. 18through64years2. 65yearsandabove














DSRIPIncentiveImpactProjectTitle:Project6–CareTransitionsInterventionModeltoReduce30‐DayReadmissionsforChronicCardiacConditions

ProjectCode:6.4



ProjectCode:7.5


ProjectTitle:Project8–TheCongestiveHeartFailureProgram(CHF‐TP)

ProjectCode:8.5


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

PediatricCentral‐LineAssociatedBloodstreamInfections(CLABSI)‐NeonatalIntensive‐CareUnitandPediatricIntensiveCareUnit

DSRIP#:63

MeasureDescription:TheCentralline‐associatedbloodstreaminfections(CLABSI)rateinpediatricandneonatalintensivecareunits,reportedper1,000devicedays.DataSource:

Chart/EHRNQF#:

NotFound

MeasureSteward:CDC


MeasureCalculationDescriptionNumerator:TotalnumberofCLABSIeventsamongpatientsinPICUsandNICUs.

Abloodstreaminfectionmustfirstbedeterminedtobeahealthcare‐associatedinfection(HAI)beforeitcanbe identifiedasaCLABSI.OnlyHAIscanbeCLABSIs.AnHAI isa localizedorsystemicconditionresultingfromanadversereactiontothepresenceofaninfectiousagent(s)oritstoxin(s)thatwasnotpresentorincubatingonadmissiontotheacutecarefacility.

OnceidentifiedasanHAI,alaboratory‐confirmedbloodstreaminfection(LCBI)isfurtheridentifiedasaCLABSIifacentralline(CL)orumbilicalcatheter

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thetotalcentrallinedevice‐daysamongpatientsinPICUsandNICUsforthemeasurementperiod.

Result:Theresultisexpressedasarate.TherateiscalculatedasthenumberofidentifiedCLABSIeventsoverthenumberofcentrallinedevicedaysmultipliedby1000.ImprovementDirection:Lower

MeasureQualifications:SeemeasurestewardspecificationformoredetailsonhowtoidentifyCLABSIevents.Definitionofdevicedays:adailycountofthenumberofpatientswithaspecificdevice(i.e.centralline)inplaceinapatientcarelocation.DevicedaysareusedfordenominatorsinCLABSIrates.Devicedaydenominatordatathatarecollecteddifferaccordingtothelocationofthepatientsbeingmonitored.

a.ForICUs,thenumberofpatientswithoneormorecentrallinesofanytypeiscollecteddaily,atthesametimeeachdayduringthemonth.Thetotalsforthemonthareentered.



b.InNICUs,thenumberofpatientswithoneormorecentrallines(includingumbilicalcatheters)isstratifiedbybirthweightinfivecategoriessinceriskofBSIvariesbybirthweight.IntensiveCareUnit–Anursingcareareainwhichatleast80percentofthepatientsmatchdefinitionsofcriticalcarelocationsfoundinchapter15,MasterCDCLocationsandDescriptions,oftheNHSNPatientSafetyComponentManual.http://www.cdc.gov/nhsn/PDFs/pscManual/15LocationsDescriptions_current.pdfCentralLine–Anintravascularcatheterthatterminatesatorclosetotheheartorinoneofthegreatvesselswhichisusedforinfusion,withdrawalofblood,orhemodynamicmonitoring.ThefollowingareconsideredgreatvesselsforthepurposeofreportingCLABSIandcountingcentral‐linedays:

Aorta,pulmonaryartery,superiorvenacava,inferiorvenacava,brachiocephalicveins,internaljugularveins,subclavianveins,externaliliacveins,commoniliacveins,femoralveinsandinneonates,theumbilicalartery/vein.Note:Neithertheinsertionsitenorthetypeofdevicemaybeusedtodetermineifalinequalifiesasacentralline.Thedevicemustterminateinoneofthegreatvesselsorinorneartheheartandbeusedforoneofthepurposesoutlinedabovetoqualifyasacentralline.

Infusion–Theintroductionofasolutionthroughabloodvesselviaacatheterlumen.Thismayincludecontinuousinfusionssuchasnutritionalfluidsormedications,oritmayincludeintermittentinfusionssuchasflushesorIVantimicrobialadministration,orblood,inthecaseoftransfusionorhemodialysis.Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualifications/definitionsanddatacollection.Thisisprovidedwithoutassurances:

https://www.medicaid.gov/medicaid/quality-of-care/downloads/medicaid-and-chip-child-core-set-manual.pdf






NAAbsoluteITGValue:

NAAttributionDate:


NA





ProjectCode:NA

PaymentMethod:NA


UniversalCode:38

PaymentMethod:UPP



Measure:

Percentofhospitalizedpatientswhoarescreenedduringthehospitalstayusingavalidatedscreeningquestionnaireforunhealthyalcoholuse

DSRIP#:64

MeasureDescription:Percentageofhospitalizedpatientswhoarescreenedwithinthefirstthreedaysduringthehospitalstayusingavalidatedscreeningquestionnaireforunhealthyalcoholuse.DataSource:

Chart/EHRNQF#:

1661


MeasureStewardVersion:2017v5.2a

MeasureCalculationDescriptionNumerator:Thenumberofpatientswhowerescreenedforalcoholuseusingavalidatedscreeningquestionnaireforunhealthydrinkingwithinthefirstthreedaysofadmission.NumeratorInclusion(s):

1. Patientswithabloodalcoholtestindicativeofacuteintoxication2. Patientswhorefusedscreening

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thosewhoarehospitalizedinpatients18yearsofageandolder.Exclusion(s):

1. Patientslessthan18yearsofage.2. Patientswhoarecognitivelyimpaired.3. Patientswhohaveadurationofstaylessthanorequaltothreedaysorgreaterthan120

days.4. PatientswithComfortMeasuresOnlydocumented.


MeasureQualifications:DataElements:Numerator:

AlcoholUseStatus

Denominator:



AdmissionDate BirthDate ComfortMeasuresOnly DischargeDate



PleaseNote:ComfortMeasuresOnlyreferstomedicaltreatmentofadyingpersonwherethenaturaldying process is permitted to occur while assuring maximum comfort. It includes attention to thepsychologicalandspiuritualneedsofthepatientandsupportforboththedyingpatientandthepatient’sfamily.ComfortMeasuresOnlyiscommonlyreferredtoas“comfortcare”bythegeneralpublic.ItisnotequivalenttoaphysicianordertowithholdemergencyresuscitativemeasuressuchasDoNoResuscitate(DNR).









DSRIPIncentiveImpactProjectTitle:Project9‐Hospital‐WideScreeningforSubstanceUseDisorder

ProjectCode:9.1


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Percentofpatientsevaluatedforenvironmentaltriggersotherthanenvironmentaltobaccosmoke(dustmites,cats,dogs,molds/fungi)

DSRIP#:65

MeasureDescription:Percentageofpatientsevaluatedforenvironmentaltriggersotherthanenvironmentaltobaccosmoke(dustmites,cats,dogs,molds/fungi,cockroaches)eitherbyhistoryofexposureand/orbyallergytesting.DataSource:

Chart/EHRNQF#:

NotFound

MeasureSteward:HRSA

MeasureStewardVersion:October2015

MeasureCalculationDescriptionNumerator:Thenumberofpatientsevaluatedforenvironmentaltriggersotherthanenvironmentaltobaccosmoke(e.g.dustmites,cats,dogs,molds/fungi,cockroaches)eitherbyhistoryofexposureand/orbyallergytesting.

Note:The"indoor"environmentaltriggersherearethosehavingthestrongestevidenceofcausal

relationshiptoasthma.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientsunder18yearsofagewithadiagnosisofasthma.(AppendixA‐45)


MeasureQualifications:Thismeasureisoneof11measuresthatparticipantstrackintheHRSAHealthDisparitiesCollaborativeforAsthma.Pleasenote:TheagerangefollowstheyoungestagegroupfortheMedicaidAdultCoremeasureSet.Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances:

http://www.qualitymeasures.ahrq.gov/content.aspx?id=27598




SettingofCare:Outpatient

ReportingPeriod:1stSemi‐Annual=April2ndSemi‐Annual=October






DSRIPIncentiveImpactProjectTitle:Project2‐PediatricAsthmaCaseManagementandHomeEvaluations

ProjectCode:2.6

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Percentageofpatientsagedgreaterthanorequalto18yearsdiagnosedwithcommunity‐acquiredbacterialpneumoniawhohadachestx‐ray

DSRIP#:70

MeasureDescription:Percentageofpatientsage18yearsandolderdiagnosedwithcommunity‐acquiredbacterialpneumoniawhohadachestx‐rayperformed.DataSource:

Chart/EHRNQF#:

NotFound



MeasureCalculationDescriptionNumerator:Patientswithachestx‐rayperformed.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientsaged18yearsandolderwithcommunity‐acquiredbacterialpneumonia.(AppendixA‐34)Exclusion(s):

1. Documentationofmedicalreason(s)fornotperformingachestx‐ray.2. Documentationofpatientreason(s)fornotperformingachestx‐ray(e.g.,economic,social,

religious,otherpatientreasons).3. Documentationofsystemreason(s)fornotperformingachestx‐ray(e.g.,equipmentnot

available).



https://download.ama‐assn.org/resources/doc/pcpi/capminiset062007.pdfThismeasureisnolongerincludedintheAMAMeasureSet











DSRIPIncentiveImpactProjectTitle:Project17‐PatientsReceiveRecommendedCareforCommunity‐AcquiredPneumonia

ProjectCode:17.1


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

PercentageofpatientswithBMI>=25whosetanindividualizedgoalalongwithtargetdateforreductioninbodymassindex

DSRIP#:71

MeasureDescription:Percentageofpatientsaged18yearsandyoungerwithadocumentedbodymassindex(BMI)duringthecurrentencounterorduringtheprevioussixmonthsANDwhentheBMIisoutsideofnormalparameters,afollow‐upplanisdocumentedduringtheencounterorduringtheprevioussixmonthsoftheencounter.DataSource:

Chart/EHRNQF#:

Basedon0421

MeasureSteward:ICSI

MeasureStewardVersion:May2013

MeasureCalculationDescriptionNumerator:PatientswithBMIcalculatedwithinthepastsixmonthsorduringthecurrentvisit,follow‐upisdocumentedduringtheencounterorduringtheprevioussixmonthsoftheencounterwiththeBMIoutsideofnormalparameters.(AppendixA–35)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,allpatientsaged18yearsandyounger.Exclusion(s):

1. Patientispregnant2. PatientrefusesBMImeasurement3. Ifthereisanyotherreasondocumentedinthemedicalrecordbytheproviderexplaining

whyBMImeasurementoffollow‐upplanwasnotappropriate4. Patientisinanurgentoremergentmedicalsituationwheretimeisoftheessenceandto

delaytreatmentwouldjeopardizethepatient’shealthstatus


MeasureQualifications:NumeratorNote:CalculatedBMIorfollow‐upplanforBMIoutsideofnormalparametersthatisdocumentedinthemedicalrecordmaybereportedifdoneintheprovider’soffice/facilityorifobtainedbytheproviderfromoutsidemedicalrecordswithinthepastsixmonths.Thedocumentedfollow‐upinterventionsmustberelatedtotheBMIoutsideofnormalparameters(i.e.,patientreferredtonutritioncounselingforBMIabovenormalparameters).



BMI–Bodymassindex(BMI)isexpressedasweight/height(BMI;kg/m2)andiscommonlyusedtoclassifyweightcategories.CalculatedBMI–Requiresaneligibleprofessionalortheirstafftomeasureboththeheightandweight.Self‐reportedvaluescannotbeused.BMIiscalculatedeitherasweightinpoundsdividedbyheightininchessquaredmultipliedby703,orasweightinkilogramsdividedbyheightinmeterssquared.Follow‐upPlan–ProposedoutlineoftreatmenttobeconductedasaresultofaBMImeasurementoutofnormalparameters.Suchfollow‐upmayincludebutisnotlimitedto:

Documentationofafutureappointment Education Referral(suchas,aregistereddietician,nutritionist,occupationaltherapist,physicaltherapist,

primarycarephysician,exercisephysiologist,mentalhealthprofessional,surgeon) Pharmacologicalinterventions Dietarysupplements Exercisecounseling Nutritioncounseling

Pleasenote:ThemeasurestewardagestratificationagegroupingshavebeenadjustedtofollowtheMedicaidAdultCoremeasuresetagecategory18yearsandyounger.Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualifications/definitionsanddatacollection.Thisisprovidedwithoutassurances:









DSRIPIncentiveImpactProjectTitle:Project15–After‐SchoolObesityProgram

ProjectCode:15.1


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Post‐DischargeAppointmentforHeartFailurePatients

DSRIP#:73

MeasureDescription:Percentageofpatients,regardlessofage,dischargedfromaninpatientfacilitytoambulatorycareorhomehealthcarewithaprincipaldischargediagnosisofheartfailureforwhomafollowupappointmentwasscheduledanddocumentedpriortodischarge.DataSource:

Chart/EHRNQF#:

NotFound


MeasureStewardVersion:May2012

MeasureCalculation DescriptionNumerator:Patientsforwhomafollowupappointmentwasscheduledanddocumentedpriortodischargeincludingeither:

1. Anofficevisit(includinglocation,dateandtime)formanagementofheartfailurewithaphysician,advancedpracticenurse,physicianassistant.(AppendixA‐32)

2. Ahomehealthvisit(includinglocationanddate)formanagementofheartfailureDuetothenatureofschedulinghomehealthvisits,thelocationanddateofthefollow‐upappointmentissufficientformeetingthemeasure.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,allpatients,regardlessofage,dischargedfromaninpatientfacility(i.e.hospitalinpatientorobservation)toambulatorycare(home/selfcare)orhomehealthcarewithaprincipaldischargediagnosisofheartfailure(Table73.1)(AppendixA‐30).Table73.1CodestoIdentifyHeartFailure(AppendixA‐30),(AppendixA‐32)

CodeType

Code

CPT 99201‐99203,99205,99212‐9921599241‐99245,99304‐99310,99324‐99328,99334‐99337,99341‐99345,99347‐99350

ICD‐9 402.01,402.11,402.91,404.01,404.03,404.11,404.13,404.91,404.93,428.0,428.1,428.20‐428.23,428.30‐428.33,428.40‐

428.43,428.9

ICD‐10 I11.0,l13.0,l13.2,I50.20‐23,I50.30‐33,I50.40‐43,I50.9,l50.1,l50.20‐l50.23,l50.30‐l50.33,l50.40‐l50.43,l50.9



AND UB‐04(FormLocator04‐ TypeofBill)

0111 Hospital,Inpatient,AdmitthroughDischargeClaim0121 Hospital,Inpatient–MedicarePartBonly,AdmitthroughDischargeClaim0114 Hospital,Inpatient,LastClaim0124 Hospital,Inpatient–MedicarePartBonly,Interim‐LastClaim

ANDDischargeDisposition—ondayofdischargeonly

1 HomeIncludesassistedlivingfacilities,court/lawenforcement(detentionfacilities,jails,andprison),fosterorresidentialcare,grouporpersonalcarehomes,andhomelessshelters,homewithhomehealthservices,outpatientservicesincludingoutpatientproceduresatanotherhospital,outpatientchemicaldependencyprograms,andpartialhospitalization.Exclusion(s):

1. Documentationofmedicalreason(s)fornotdocumentingthatafollowupappointmentwasscheduled.

2. Patientswhoexpired.3. Patientswholeftagainstmedicaladvice(AMA)ordiscontinuedcare.4. Patientsdischargedtohospice.



BirthDate DiagnosisCode(s) ProcedureCode(s) Documentationofmedicalreasonfornotdocumentingafollowupappointmentwasscheduled DischargeStatus

Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances.

http://www.ama‐assn.org/ama1/pub/upload/mm/pcpi/hfset‐12‐5.pdfThismeasureisnolongerincludedintheAMAMeasureSet












ProjectCode:6.3



ProjectCode:7.4



ProjectCode:8.4


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

PostoperativeSepsis

DSRIP#:74

MeasureDescription:Percentageofostoperativesepsiscases(secondarydiagnosis)per1,000electivesurgicaldischargesforpatientsages18yearsandolder.DataSource:

Chart/EHRNQF#:

NotFound

MeasureSteward:AHRQ


MeasureCalculationDescriptionNumerator:Discharges,amongcasesmeetingtheinclusionandexclusionrulesforthedenominator,withanysecondaryICD‐9‐CM/ICD‐10‐CMdiagnosiscodesforsepsis.Table74.1:CodestoIdentifySepsiscodes(AppendixA‐29)

CodeType Codes

ICD‐9‐CM038.0,038.10‐12,038.19,038.2‐038.3,038.3,038.40‐038.44,038.49,038.8‐9,785.52,995.91‐995.92,998.02,003.1,022.3,027.0‐027.1,098.89,112.5

ICD‐10‐CM

A02.1,A22.7,A26.0,A26.7,A26.8‐A26.9,A32.0,A32.7,A32.11‐A32.12,A32.81‐A32.82,A32.89,A32.9,A40.0‐A40.3,A40.8‐9,A41.01‐A41.02,A41.1‐A41.4,A41.50‐A41.53,A41.59,A41.81,A41.89,A54.82,A54.84,A41.9,A42.7,A54.86,A54.89,A54.9,B37.7,R65.20‐R65.21,T81.12XA

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosewithelectivesurgicaldischarges,forpatientsages18yearsandolder,withany‐listedICD‐9‐CM/ICD‐10‐CMprocedurecodesforanoperatingroomprocedure.(AppendixA‐93andAppendixA‐94)ElectivesurgicaldischargesaredefinedbyspecificDRGorMS‐DRGcodeswithadmissiontyperecordedaselective(SIDATYPE=3).Exclusion(s):

1. PatientswithaprincipalICD‐9‐CM/ICD‐10‐CMdiagnosiscode(orsecondarydiagnosispresentonadmission)forsepsis(seeabove)(AppendixA‐29)

2. PatientswithaprincipalICD‐9‐CM/ICD‐10‐CMdiagnosiscode(orsecondarydiagnosispresentonadmission)forinfectionorpressureulcer(AppendixA‐36)

3. Patientswithany‐listedICD‐9‐CM/ICD‐10‐CMdiagnosiscodesorany‐listedICD‐9‐CM/ICD‐10‐CMprocedurecodesforimmunocompromisedstate(AppendixA‐37)

4. Patientswithany‐listedICD‐9‐CM/ICD‐10‐CMdiagnosiscodesforcancer(AppendixA‐38)5. Patientswithlengthofstayoflessthan4days6. PatientswithanMDC14(pregnancy,childbirth,andpuerperium)(AppendixA‐92)

Patientswithmissinggender,age,quarter,year,orprincipaldiagnosis

Result:



Theresultisexpressedasarateper1,000.ImprovementDirection:Lower


http://www.qualityindicators.ahrq.gov/

Linktomeasurestewardappendixprocedurecodeanddiagnosiscodedocumentation:http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50‐

ICD10/TechSpecs/PSI_Appendix_A.pdfhttp://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50‐ICDhttp://www.qualityindicators.ahrq.gov/Modules/PSI_TechSpec_ICD10.aspx

10/TechSpecs/PSI_Appendix_D.pdf









ProjectCode:NA

PaymentMethod:NA


UniversalCode:37

PaymentMethod:UPP



Measure:

PreventiveCareandScreening:TobaccoUse:ScreeningandCessationIntervention

DSRIP#:76

MeasureDescription:Percentageofpatientsaged18yearsandolderwithadiagnosisofcoronaryarterydiseaseseenwithina12monthperiodwhowerescreenedfortobaccouseANDwhoreceivedtobaccocessationcounselinginterventionifidentifiedasatobaccouser.DataSource:

Chart/EHRNQF#:

0028


MeasureStewardVersion:v1.02016

MeasureCalculationDescriptionNumerator:PatientswhowerescreenedfortobaccouseANDwhoreceivedtobaccocessationcounselingintervention,ifidentifiedasatobaccouser.Allpatientsaged18yearsandolderwithadiagnosisofcoronaryarterydisease(AppendixA‐39)seenwithina12monthperiodshouldbescreenedfortobaccouse(evenlife‐longnon‐smokers).Ifidentifiedasatobaccouser,tobaccocessationcounselingshouldalsobeprovided.(AppendixA–58)NumeratorInclusionCriteria:

1. Patientsscreenedfortobaccouse.(Table761.1)2. Patientsidentifiedastobaccousers.(Table761.1)3. Patientswhoreceivedtobaccocessationcounselingintervention(Table761.1)and/or

pharmacotherapy.(Table761.2)

Table76.1:CodestoIdentifyTobaccoScreening,Use,Non‐Use,CessationIntervention(AppendixA‐58)CPTCode Description1000F TOBACCOUSEASSESSED

1034F CURRENTTOBACCOSMOKER

1035F CURRENTSMOKELESSTOBACCOUSER

1036F CURRENTTOBACCONON‐USER

AND

4000F TOBACCOUSECESSATIONINTERVENTIONCOUNSELING

4001F TOBACCOUSECESSATIONINTERVENTION,PHARMACOLOGICTHERAPY

4004F SCREENEDFORTOBACCAUSEANDCESSATIONINTERVENTIONCOUNSELING,PHARMACOLOGICTHERAPYORBOTH

OR

99406 SMOKING/TOBACCOCOUNSELING3‐10MINUTES

99407 SMOKING/TOBACCOCOUNSELINGGREATERTHAN10MINUTES

Thefollowinglistofmedications/drugnamesisbasedonclinicalguidelinesandotherevidenceandmaynotbeall‐inclusiveorcurrent.PhysiciansandotherhealthcareprofessionalsshouldrefertotheFDA’swebsitepageentitledDrugSafetyCommunicationsforup‐to‐daterecallandalertinformationwhenprescribingmedication.



Table76.2:MedicationstoIdentifyPharmacotherapyDescription DrugName

NicotineTreatment TransdermalPatch Lozenge InhalantSolution NasalSpray ChewingGum SublingualTablet

Antidepressant BupropionSustainedReleaseSmokingDeterrent Vareniciline

Denominator:OftheNewJerseyLowIncomeattributedpopulation,allpatientsaged18yearsandolderwithadiagnosisofcoronaryarterydisease(RefertoAppendixA‐39)seenwithina12monthperiod.



Numerator TobaccoScreening/AssessmentCode TobaccoUser/Non‐UserCode CessationInterventionCode PharmacotherapyMedication(s)

Denominator

BirthDate ICD‐9‐CM/ICD‐10‐CMPrincipalDiagnosisCode ICD‐9‐CM/ICD‐10‐CMOtherDiagnosisCode DateofAmbulatoryVisit

Tobaccoscreeningincludesanytypeoftobacco.Cessationcounselinginterventionincludesbriefcounseling(3minutesorless),and/orpharmacotherapy.Thelistofpharmacotherapymedications(Table761.2)isbasedonclinicalguidelinesandotherevidenceandmaynotbeall‐inclusiveorcurrent.RefertotheFDA’swebsitepageentitled“DrugSafetyCommunications”forup‐todatedruginformation.


http://www.ama‐assn.org/ama1/pub/upload/mm/pcpi/cadminisetjune06.pdfThismeasureisnolongerincludedintheAMAMeasureSet










DSRIPIncentiveImpactProjectTitle:Project6–CareTransitionsInterventionModeltoReduce30‐DayReadmissionsforChronicCardiacConditions


PaymentMethod:P4P



PaymentMethod:P4P

ProjectTitle:Project8–TheCongestiveHeartFailureTransitionProgram(CHF‐TP)


PaymentMethod:P4P


UniversalCode:19




Measure:

ScreeningforClinicalDepressionandFollow‐upPlan

DSRIP#:79

MeasureDescription:Percentageofpatientsaged12yearsandolderscreenedforclinicaldepressiononthedateofencounterusinganageappropriatestandardizeddepressionscreeningtoolAND,ifpositive,afollow‐upplanisdocumentedonthedateofthepositivescreen.DataSource:

Chart/EHRNQF#:

0418

MeasureSteward:CMS

MeasureStewardVersion:2017CMS2.5

MeasureCalculationDescriptionNumerator:PatientsscreenedforclinicaldepressiononthedateoftheencounterusinganageappropriatestandardizedtoolAND,ifpositive,afollow‐upplanisdocumentedonthedateofthepositivescreen.(AppendixA‐349)Screening–Completionofaclinicalordiagnostictoolusedtoidentifypeopleatriskofdevelopingorhavingacertaindiseaseorcondition,evenintheabsenceofsymptoms.StandardizedDepressionScreeningTool–Anormalizedandvalidateddepressionscreeningtooldevelopedforthepatientpopulationinwhichitisbeingutilized.Examplesofdepressionscreeningtoolsincludebutarenotlimitedto: AdolescentScreeningTools(12‐17years)

PatientHealthQuestionnaireforAdolescents(PHQ‐A),BeckDepressionInventory‐PrimaryCareVersion(BDI‐PC),MoodFeelingQuestionnaire(MFQ),CenterforEpidemiologicStudiesDepressionScale(CES‐D),andPRIMEMD‐PHQ2

AdultScreeningTools(18yearsandolder)PatientHealthQuestionnaire(PHQ‐9),BeckDepressionInventory(BDIorBDI‐II),CenterforEpidemiologicStudiesDepressionScale(CES‐D),DepressionScale(DEPS),DukeAnxiety‐DepressionScale(DADS),GeriatricDepressionScale(GDS),CornellScaleScreening,andPRIMEMD‐PHQ2

Follow‐UpPlan–Proposedoutlineoftreatmenttobeconductedasaresultofpositiveclinicaldepressionscreening.Follow‐upforapositivedepressionscreeningmustincludeone(1)ormoreofthefollowing:

Additionalevaluation SuicideRiskAssessment Referraltoapractitionerwhoisqualifiedtodiagnoseandtreatdepression Pharmacologicalinterventions Otherinterventionsorfollow‐upforthediagnosisortreatmentofdepression

NumeratorExclusionsCriteria

Apatientisnoteligibleifoneormoreofthefollowingconditionsexist:

1. Patientrefusestoparticipate.



2. Patientisinanurgentoremergentsituationwheretimeisoftheessenceandtodelaytreatmentwouldjeopardizethepatient’shealthstatus.

3. Situationswherethepatient’sfunctionalcapacityormotivationtoimprovemayimpacttheaccuracyofresultsofnationallyrecognizedstandardizeddepressionassessmenttools.Forexample:certaincourtappointedcasesorcasesofdelirium.

4. PatienthasanactivediagnosisofDepressionorBipolarDisorder.

Denominator:OftheNewJerseyLowIncomeattributedpopulation,patientsaged12yearsandolderwithoneofthefollowingencountertypes:(AppendixA‐73)



Iftheproviderisnotcurrentlyutilizingastandarddepressionscreeningtool,thiswouldhavetobeimplementedduringthepilotperiod.


http://www.medicaid.gov/Medicaid‐CHIP‐Program‐Information/By‐Topics/Quality‐of‐Care/Downloads/Medicaid‐Adult‐Core‐Set‐Manual.pdfhttps://ecqi.healthit.gov/ecqm/measures/cms002v5










ProjectCode:5.3


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

SubstanceUseDisorders:ScreeningforDepressionAmongPatientswithSubstanceAbuseorDependence

DSRIP#:68

MeasureDescription:Thepercentageofpatientsaged18yearsandolderwithadiagnosisofcurrentsubstanceabuseordependencewhowerescreenedfordepressionwithinthe12monthreportingperiod.DataSource:

Chart/EHRNQF#:

Retired2014


MeasureStewardVersion:V8.02013

MeasureCalculationDescriptionNumerator:Patientswhowerescreenedfordepressionwithinthe12monthreportingperiod.(CPTCategoryIIcode:1220F–Patientsscreenedfordepression)(AppendixA‐97)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,allpatients18yearsandolderwithadiagnosisofdepressionorcurrentsubstanceabuseordependence.Diagnosiscode(AppendixA‐95)ANDServicecode(AppendixA‐96)Exclusion(s):

1. Documentationofmedicalreason(s)fornotscreeningfordepressionwithinthe12monthreportingperiod.(AppendmodifiertoCPTCategoryII:1220F‐1P)(AppendixA‐98)



Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecification.Thisisprovidedwithoutassurances.

http://www.ama‐assn.org/ama1/pub/upload/mm/pcpi/sud_ws_final.pdfThismeasureisnolongerincludedintheAMAMeasureSet











DSRIPIncentiveImpactProjectTitle:Project9–Hospital‐wideScreeningforSubstanceUseDisorder

ProjectCode:9.2


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

TimelyTransmissionofTransitionRecord

DSRIP#:80

MeasureDescription:Percentageofpatients,regardlessofage,dischargedfromaninpatientfacilitytohomeoranyothersiteofcareforwhomatransitionrecordwastransmittedtothefacilityorprimaryphysicianorotherhealthcareprofessionaldesignatedforfollow‐upcarewithin24hoursofdischarge.DataSource:

Chart/EHRNQF#:

0648



MeasureCalculationDescriptionNumerator:Patientsforwhomatransitionrecordwastransmittedtothefacilityorprimarycarephysicianorotherhealthcareprofessionaldesignatedforfollow‐upcarewithin24hoursofdischarge.Transitionrecord‐acore,standardizedsetofdataelementsrelatedtopatient’sdiagnosis,treatment,andcareplanthatisdiscussedwithandprovidedtopatientinprintedorelectronicformatateachtransitionofcare,andtransmittedtothefacility/physician/otherhealthcareprofessionalprovidingfollow‐upcare.Electronicformatmaybeprovidedonlyifacceptabletopatient.Transmitted‐transitionrecordmaybetransmittedtothefacilityorphysicianorotherhealthcareprofessionaldesignatedforfollow‐upcareviafax,securee‐mail,ormutualaccesstoanelectronichealthrecord(EHR).Primaryphysicianorotherhealthcareprofessionaldesignatedforfollow‐upcare‐maybeadesignatedprimarycarephysician(PCP),medicalspecialist,orotherphysicianorhealthcareprofessional

Denominator:OftheNewJerseyLowIncomeattributedpopulation,allpatients,regardlessofage,dischargedfromaninpatientfacility(i.e.hospitalinpatient)tohome/selfcareoranyothersiteofcarewithadiagnosisofcareorworkingdiagnosisofCongestiveHeartFailure(CHF)AppendixA‐30.SeeTable80.1forcodestoidentifypatientsdischargedfromaninpatientfacility



Table80.1:CodestoIdentifyPatientsDischargedfromInpatientFacilityTypeofBill

(FormLocator04,UB‐04)

RevenueCode(FormLocator42,UB‐04)

DischargeStatus(FormLocator17,

UB‐04)0111,0121,0114,0124,0211,0214,0221,0224,0281,0284,0131,0134

AND AND01,02,03,04,05,06,43,50,51,61,62,63,64,65,66,70,

0131,0134 AND 0762,0490,0499 AND01,02,03,04,05,06,43,50,51,61,62,63,64,65,66,70,

Exclusion(s):

Patientswhoexpired.(Table80.2) Patientswholeftagainstmedicaladviceordiscontinuedcare.(Table80.2)

Table80.2:CodestoIdentifyDischargeExclusions(AppendixA‐346)

DischargeStatus(FormLocator17,

UB‐04)

07–LeftAgainstMedicalAdviceorDiscontinuedCare20–Expired40–ExpiredatHome41–ExpiredinaMedicalFacility42–Expired,PlaceUnknown



DiagnosisofCare(WorkingDiagnosis) PatientDischargeStatusCode Dischargedate PatientDischargeSummaryTransmissionDate

TheadditionofthediagnosiswasincludedtotrackonlyCHFdischarges.Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecifications.Thisisprovidedwithoutassurances:

http://www.ama‐assn.org/ama1/pub/upload/mm/pcpi/care‐transitions‐ms.pdfThismeasureisnolongerincludedintheAMAMeasureSet











DSRIPIncentiveImpactProjectTitle:Project6‐CareTransitionsInterventionModeltoReduce30‐DayReadmissionsforChronicCardiacConditionsA

ProjectCode:6.9

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

WeightAssessmentandCounselingforNutritionandPhysicalActivityforChildren/Adolescents

DSRIP#:87

MeasureDescription:Percentageofpatients3‐17yearsofagewhohadanoutpatientvisitwithaPCPorOB/GYNandwhohadevidenceofthefollowingduringthemeasurementyear:

1. BodyMassIndex(BMI)percentiledocumentation*2. Counselingfornutrition3. Counselingforphysicalactivity

*BecauseBMInormsforyouthvarywithageandgender,thismeasureevaluateswhetherBMIpercentileisassessedratherthananabsoluteBMIvalue.DataSource:

Chart/EHRNQF#:

0024

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhohadanoutpatientvisit(AppendixA‐32)withaPCPorOB/GYNandwhohadevidenceofthefollowingduringthemeasurementyear:

1. BMIpercentileduringthemeasurementyear.(Table87.1)(AppendixA‐42)2. Counselingfornutrition(Table87.1)(AppendixA‐40)orreferralfornutritioneducation

duringthemeasurementyear.3. Counselingforphysicalactivity(Table87.1)(AppendixA‐41)orreferralforphysical

activityduringthemeasurementyear.

Table87.1:CodestoIdentifyBMIPercentile,CounselingforNutritionandCounselingforPhysicalActivity

Description CPTICD‐9‐CMDiagnosis

ICD‐10CMDiagnosis HCPCS

BMIpercentile V85.51‐V85.54

Z68.51‐Z68.54

Counselingfornutrition 97802‐97804

V65.3 Z71.3

G0270,G0271,S9449,S9452,S9470,G0447

Counselingforphysicalactivity

V65.41 Z71.89 S9451,G0447

NumeratorInclusionCriteria:BMIPercentile:Documentationmustincludeheight,weightandBMIpercentileduringthemeasurementyear.Theheight,weightandBMImustbefromthesamedatasource.EitherofthefollowingmeetscriteriaforBMIpercentile:



BMIpercentile,or BMIpercentileplottedonage‐growthchart.

CounselingforNutrition:Documentationmustincludeanoteindicatingthedateandatleastoneofthefollowing:

Discussionofcurrentnutritionbehaviors(e.g.,eatinghabits,dietingbehaviors). Checklistindicatingnutritionwasaddressed. Counselingorreferralfornutritioneducation. Memberreceivededucationalmaterialsonnutrition. Anticipatoryguidancefornutrition. Weightorobesitycounseling.

CounselingforPhysicalActivity:Documentationmustincludeanoteindicatingthedateandatleastoneofthefollowing:

Discussionofcurrentphysicalactivitybehaviors(e.g.,exerciseroutine,participationinsportsactivities,examforsportsparticipation).

Checklistindicatingphysicalactivitywasaddressed. Counselingorreferralforphysicalactivity. Memberreceivededucationalmaterialsonphysicalactivity. Anticipatoryguidancespecifictothechild’sphysicalactivity. Weightorobesitycounseling.

NumeratorExclusionsCriteria:Thefollowingnotationsorexamplesofdocumentationdonotcountasnumeratorcompliant:BMI:

NoBMIorBMIpercentiledocumentedinmedicalrecordorplottedonage‐growthchart. Notationofheightandweightonly.

NutritionandDiet:

Nocounseling/educationonnutritionanddiet. Counseling/educationbeforeorafterthemeasurementyear. Notationof“healtheducation”or“anticipatoryguidance”withoutspecificmentionof

nutrition. Aphysicalexamfindingorobservationalone(e.g.,well‐nourished)isnotcompliant

becauseitdoesnotindicatecounselingfornutrition.

PhysicalActivity:

Nocounseling/educationonphysicalactivity. Notationof“clearedforgymclass”alonewithoutdocumentationofadiscussion. Counseling/educationbeforeorafterthemeasurementyear. Notationof“healtheducation”or“anticipatoryguidance”withoutspecificmentionof

physicalactivity. Notationofanticipatoryguidancerelatedsolelytosafety(e.g.,wearshelmetorwater

safety)withoutspecificmentionofphysicalactivityrecommendations. Notationsolelyrelatedtoscreentime(computerortelevision)withoutspecificmentionof

physicalactivity.



Servicesmayberenderedduringavisitotherthanawell‐childvisit.Theseservicescountifthespecifieddocumentationispresent,regardlessoftheprimaryintentofthevisit.Servicesspecifictoanacuteorchronicconditiondonotcounttowardthe“Counselingfornutrition”and“Counselingforphysicalactivity”indicators.TheTotalsampleisstratifiedbyagetoreportrates:

1. 3through11yearsofage2. 12through17yearsofage3. Total3–17yearsofage

Denominator:OftheNewJerseyLowIncomeattributedpopulation,thosepatientswhoare3‐17yearsofageasofDecember31ofthemeasurementyearwhohadanoutpatientvisit(Table87.2)withaPCPoranOB/GYNduringthemeasurementyear.

Table87.2:CodestoIdentifyOutpatientVisits(AppendixA‐32)CPT UBRevenue HCPCS

99201‐99205,99211‐99215,99217‐99220,99241‐99245,99341‐99345,99347‐99350,99381‐99387,99391‐99397,99401‐99404,99411,99412,99420,99429,99455,99456

0510‐0519,0520‐0523,0526‐0529,0982,0983

G0402,G0438,G0439,G0463,T1015

Exclusion(s):Patientswhohaveadiagnosisofpregnancy(Appendix–50)duringthemeasurementyear.


MeasureQualifications:Pleasenote:Theagestratification:“Total3‐17yearsofage”willbemonitoredandapplytotheP4Pincentiveawardforthismeasure.Thefollowinglinkmaybeusedtoobtainadditionalinformationregardingthespecificinstructionsonthemeasurementqualifications/definitionsanddatacollection.Thisisprovidedwithoutassurances:










SamplingorRiskAdjustmentMethodologyThismeasureistobecollectedandreportedbythehospitalfollowingthesamplingguidanceprovidedinSectionIII.

DSRIPIncentiveImpactProjectTitle:Project4–DayProgramandSchoolSupportExpansion

ProjectCode:4.4


ProjectTitle:Project5–ElectronicSelf‐AssessmentDecisionSupportTool

ProjectCode:5.5



ProjectCode:15.3

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



MMISMeasureSpecificationForms



Measure:

30‐DayAll‐CauseReadmissionFollowingAcuteMyocardialInfarction(AMI)Hospitalization

DSRIP#:1

MeasureDescription:Thepercentageof30‐dayallcausereadmissionsfollowingacutemyocardialinfarction(AMI)hospitalization.DataSource:

MMISNQF#:

Basedon0505

MeasureSteward:CMS


MeasureCalculationDescriptionNumerator:Thenumberofunplanned30‐dayall‐causereadmissionfromthedateofdischargeoftheindexacutemyocardialinfarction(AMI)admission.(AppendixA‐340)Themeasureassessesunplannedreadmissionswithina30‐dayperiodfromthedateofdischargeofanindexadmission.Thisstandardtimeperiodisnecessarysothattheoutcomeforeachpatientismeasureduniformly.The30‐daytimeframeisaclinicallymeaningfulperiodforhospitalstocollaboratewiththeircommunitiesinanefforttoreducereadmissions.ReadmissionExclusions:

Admissionsnotcountedasreadmissions:Aspublishedinthemeasurestewardspecifications,CMSfollowsaPlannedReadmissionAlgorithmbasedonthreeprinciples(AppendixB‐350):

1. Afewspecific,limitedtypesofcarearealwaysconsideredplanned(obstetricdelivery,transplantsurgery,maintenancechemotherapy/radiotherapy/immunotherapy,rehabilitation);

2. Otherwise,aplannedreadmissionisdefinedasanon‐acutereadmissionforascheduledprocedure;and

3. Admissionsforacuteillnessorforcomplicationsofcareareneverplanned.Thealgorithmidentifiesadmissionsthataretypicallyplanned(AppendixB‐350)andmayoccurwithin30daysofdischargefromthehospital.Thedetailsoftheindexadmission(diagnosisorprocedures)arenotconsideredwhendeterminingwhetherareadmissionisplanned.Denominator:Ofthehospital’sattributedNewJerseyLowIncomepopulation,thetotalnumberofhospitaldischargeswithaprincipaldiagnosisofacutemyocardialinfarction(AMI)forpatientsaged18yearsandolder(AppendixA‐340).Indexadmission–isthehospitalizationconsideredforthereadmissionoutcome.PatientswithanindexhospitalizationwithinanacutecarehospitalareincludediftheyhavebeenaNewJerseyLowIncomepopulationmemberforthe365dayspriortotheIndexDischargedatethrough30daysfollowingtheindexdischargedatetoensureafullyearofadministrativedataforriskadjustment.



IndexAdmissionExclusion(s):

1. Patientswithanin‐hospitaldeath:Admissionsforpatientswithanin‐hospitaldeathareexcludedbecausetheyarenoteligibleforreadmission.

2. LessThan30DaysPost‐dischargeInformation:Admissionsforpatientswithoutatleast30dayspost‐dischargeasamemberoftheNewJerseyLowIncomepopulationareexcludedbecausethe30‐dayreadmissionoutcomecannotbeassessedforthisgroup.

3. Transfers:AdmissionsforpatientshavingaprincipaldiagnosisofAMIduringtheindex

hospitalizationandsubsequentlytransferredtoanotheracutecarefacilityareexcludedbecausethismeasureappliestodischargestonon‐acutecaresettings.

a. Admissionstoanotherhospitalwithinonedayofdischargeareconsideredtransfers,regardlessofthedispositionofthepreviousadmission.

4. DischargesAgainstMedicalAdvice(AMA):Patientswhoweredischargedagainstmedicaladvice(AMA).

5. SameDayDischarge:PatientsadmittedanddischargedonthesamedayarenotincludedbecauseitisunlikelytheseareclinicallysignificantAMIs.

6. Admissionswithin30daysofdischargefromanindexadmissionwillnotbeconsideredindexadmissions.Nohospitalizationwillbecountedasbothareadmissionandanindexadmissionwithinthesamemeasure.However,becausecohortsforthereadmissionmeasuresaredeterminedindependentlyofeachother,areadmissioninonemeasure(e.g.DSRIP#1AMI)mayqualifyasanindexadmissioninanotherreadmissionmeasure(e.g.DSRIP#2COPD).

Ifapatientisreadmittedtothesamehospitalonthesamedayofdischargeforthesameprincipaldiagnosisastheindexadmission,themeasurecombinesbothstaystoaccountfortheindexadmission.

Ifapatientisreadmittedtothesamehospitalonthesamedayastheindexadmissionwithadifferentprincipaldiagnosisfromtheindexadmission,thisisconsideredasareadmission.

Readmissionsfortransferredpatientsareattributedtothehospitalthatultimatelydischargesthepatienttoanon‐acutecaresetting(e.g.,tohomeoraskillednursingfacility).IfapatientisadmittedtoHospitalA,transferredtoHospitalB,andultimatelydischargedfromHospitalBtoanon‐acutecaresetting,areadmissionwithin30daysofdischargetoanyacutecarehospitalisattributedtoHospitalB.

Ifapatienthasmorethanoneunplannedadmissionwithin30daysofdischargefromtheindexadmission,onlythefirstoneiscountedasareadmission.

Ifthefirstreadmissionafterdischargeisplanned,thennoreadmissionisconsideredintheoutcome,regardlessofwhetherasubsequentunplannedreadmissiontakesplacebecauseitwouldbeunfairtoattributetheunplannedreadmissionbacktothecarereceivedduringtheindexadmission.




ImprovementDirection:Lower

MeasureQualifications:Pleasenote:ThemeasurestewardagestratificationisbasedonMedicareagegroupings.ThishasbeenadjustedtofollowtheMedicaidAdultCodeagecategories.TheunplannedinputfilesusedwereobtainedfromtheYaleGroup’sSASprogram(2013SAS)packagewhichismadeavailabletothepublic.

Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecificationandriskstandardizationmethodology.Thisisprovidedwithoutassurances:

http://www.jointcommission.org/core_measure_sets.aspx

http://qualitynet.org/dcs/ContentServer?cid=1219069855841&pagename=QnetPublic%2FPage%2FQnetTier4&c=Page





CY2014CY2016ClaimType(s):

01,14

01–InpatientHospital02–LongTermCare03–OutpatientHospital04–Physician05–Chiropractor06–HomeHealth07–Transportation08–Vision

09–Supplies,DME10–Podiatry11–Dental12–Pharmacy13–EPDST/Healthstart14–InstitutionalCrossover15–ProfessionalCrossover

16–Lab17–ProstheticandOrthotics18–IndependentClinic19–Psychologists21–Optometrists22–MidLevelPractitioner23–HearingAid

ContinuousEligibilityPeriod:Yes RiskAdjustment:No Sampling:No

ContinuousEligibility/RiskAdjustment/SamplingMethodologyContinuousEligibility–Thepatientistobecontinuouslyenrolledforthe365dayspriortotheIndexdischargedatethrough30dayswithnomorethana45daygapduringtheyear.


ProjectTitle:Project6‐CareTransitionsInterventionModeltoReduce30‐DayReadmissionsforChronicCardiacConditions

ProjectCode:6.7

PaymentMethod:P4P


ProjectCode:7.8

PaymentMethod:P4P


ProjectCode:8.8

PaymentMethod:P4P


UniversalCode:43

PaymentMethod:UPPSubstitution



Measure:

30‐DayAll‐CauseReadmissionFollowingChronicObstructivePulmonaryDisease(COPD)Hospitalization

DSRIP#:2

MeasureDescription:Thepercentageof30‐dayallcausereadmissionsfollowingChronicObstructivePulmonaryDisease(COPD)hospitalization.DataSource:

MMISNQF#:

Basedon1891

MeasureSteward:CMS


MeasureCalculationDescriptionNumerator:Thenumberofpatientswithunplanned30‐dayall‐causereadmissionfromthedateofdischargeoftheindexhavingaprinciplediagnosisofChronicObstructivePulmonaryDisease(COPD)admission(AppendixA‐341)oraprinciplediagnosisofrespiratoryfailure(AppendixA‐342)withasecondarydiagnosisofacuteexacerbationofCOPD(AECOPD)(AppendixA‐343).Themeasureassessesunplannedreadmissionswithina30‐dayperiodfromthedateofdischargeofanindexadmission.Thisstandardtimeperiodisnecessarysothattheoutcomeforeachpatientismeasureduniformly.The30‐daytimeframeisaclinicallymeaningfulperiodforhospitalstocollaboratewiththeircommunitiesinanefforttoreducereadmissions.

ReadmissionExclusions:




3. Admissionsforacuteillnessorforcomplicationsofcareareneverplanned.Thealgorithmidentifiesadmissionsthataretypicallyplanned(AppendixB‐350)andmayoccurwithin30daysofdischargefromthehospital.Thedetailsoftheindexadmission(diagnosisorprocedures)arenotconsideredwhendeterminingwhetherareadmissionisplanned.Denominator:Ofthehospital’sattributedNewJerseyLowIncomepopulationaged18yearsandolder,thetotalnumberofhospitaldischargeswithanacutecarehospitaladmissionhavingaprincipaldiagnosisofChronicObstructivePulmonaryDisease(COPD)(AppendixA‐341)oraprincipaldiagnosisofrespiratoryfailure(AppendixA‐342)withasecondarydiagnosisofacuteexacerbationofCOPD(AECOPD)(AppendixA‐343).Indexadmission–isthehospitalizationconsideredforthereadmissionoutcome.



PatientswithanindexhospitalizationwithinanacutecarehospitalareincludediftheyhavebeenaNewJerseyLowIncomepopulationmemberforthe365dayspriortotheIndexDischargedatethrough30daysfollowingtheindexdischargedatetoensureafullyearofadministrativedataforriskadjustment.IndexAdmissionExclusion(s):



3. Transfers:AdmissionsforpatientshavingaprincipaldiagnosisofCOPDoraprincipaldiagnosis

ofrespiratoryfailurewithasecondarydiagnosisofacuteexacerbationofCOPD(AECOPD)duringtheindexhospitalizationandsubsequentlytransferredtoanotheracutecarefacilityareexcludedbecausethismeasureappliestodischargestonon‐acutecaresettings.









Result:



Theresultisexpressedasapercentage.ImprovementDirectionLower

MeasureQualifications:Pleasenote:ThemeasurestewardagestratificationisbasedonMedicareagegroupings.ThishasbeenadjustedtofollowtheMedicaidAdultCodeagecategories.TheunplannedinputfilesusedwereobtainedfromtheYaleGroup’sSASprogrampackage(2013SASpack)madeavailabletothepublic.



https://qualitynet.org/dcs/ContentServer?cid=1228773353043&pagename=QnetPublic%2FPage%2FQnetTier4&c=Page






01,14







ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:45




Measure:

30‐DayAll‐CauseReadmissionFollowingHeartFailure(HF)Hospitalization

DSRIP#:3

MeasureDescription:Thepercentageof30‐dayallcausereadmissionsfollowingheartfailure(HF)hospitalization.DataSource:

MMISNQF#:

Basedon0330

MeasureSteward:CMS


MeasureCalculationDescriptionNumerator:Thenumberofunplanned30‐dayall‐causereadmissionsfromthedateofdischargehavingaprinciplediagnosisofheartfailure(HF)admission(AppendixA‐344).Themeasureassessesunplannedreadmissionswithina30‐dayperiodfromthedateofdischargeofanindexadmission.Thisstandardtimeperiodisnecessarysothattheoutcomeforeachpatientismeasureduniformly.The30‐daytimeframeisaclinicallymeaningfulperiodforhospitalstocollaboratewiththeircommunitiesinanefforttoreducereadmissions.

ReadmissionExclusions:




3. Admissionsforacuteillnessorforcomplicationsofcareareneverplanned.Thealgorithmidentifiesadmissionsthataretypicallyplanned(AppendixB‐350)andmayoccurwithin30daysofdischargefromthehospital.Thedetailsoftheindexadmission(diagnosisorprocedures)arenotconsideredwhendeterminingwhetherareadmissionisplanned.Denominator:Ofthehospital’sattributedNewJerseyLowIncomepopulation,thetotalnumberofhospitaldischargeswithanacuteadmissionhavingaprincipaldiagnosisofheartfailure(HF)(AppendixA‐344).Indexadmission–isthehospitalizationconsideredforthereadmissionoutcome.PatientswithanindexhospitalizationwithinanacutecarehospitalareincludediftheyhavebeenaNewJerseyLowIncomepopulationmemberforthe365dayspriortotheIndexDischargedatethrough30daysfollowingtheindexdischargedatetoensureafullyearofadministrativedataforriskadjustment.IndexAdmissionExclusion(s):





3. Transfers:AdmissionsforpatientshavingaprincipaldiagnosisofHFduringtheindexhospitalizationandsubsequentlytransferredtoanotheracutecarefacilityareexcludedbecausethismeasureappliestodischargestonon‐acutecaresettings.









Result:Theresultisexpressedasarate.ImprovementDirectionLower




Pleasenote:ThemeasurestewardagestratificationisbasedonMedicareagegroupings.ThishasbeenadjustedtofollowtheMedicaidAdultCodeagecategories.TheunplannedinputfilesusedwereobtainedfromtheYale’sGroupSASprogrampackage(2013SASpack)madeavailabletothepublic.








01,14








ProjectCode:6.6

PaymentMethod:P4P


ProjectCode:7.7

PaymentMethod:P4P


ProjectCode:8.7

PaymentMethod:P4P


UniversalCode:42




Measure:

30‐DayAll‐CauseReadmissionFollowingPneumoniaHospitalization

DSRIP#:4

MeasureDescription:Thepercentageof30‐dayallcausereadmissionsfollowingpneumonia(PN)hospitalization.DataSource:

MMISNQF#:

Basedon0506

MeasureSteward:CMS


MeasureCalculationDescriptionNumerator:Thenumberof30‐dayall‐causeunplannedreadmissionfromthedateofdischargeoftheindexpneumonia(PN)(AppendixA‐345).ReadmissionExclusions:




3. Admissionsforacuteillnessorforcomplicationsofcareareneverplanned.Thealgorithmidentifiesadmissionsthataretypicallyplanned(AppendixB‐350)andmayoccurwithin30daysofdischargefromthehospital.Thedetailsoftheindexadmission(diagnosisorprocedures)arenotconsideredwhendeterminingwhetherareadmissionisplanned.Denominator:Ofthehospital’sattributedNewJerseyLowIncomepopulationaged18yearsandolder,thetotalnumberofpatientswithaprincipaldiagnosisofpneumonia(PN)(AppendixA‐345).Indexadmission–isthehospitalizationconsideredforthereadmissionoutcome.PatientswithanindexhospitalizationwithinanacutecarehospitalareincludediftheyhavebeenaNewJerseyLowIncomepopulationmemberforthe365dayspriortotheIndexDischargedatethrough30daysfollowingtheindexdischargedatetoensureafullyearofadministrativedataforriskadjustment.IndexAdmissionExclusion(s):





3. Transfers:AdmissionsforpatientshavingaprincipaldiagnosisofPNduringtheindex

hospitalizationandsubsequentlytransferredtoanotheracutecarefacilityareexcludedbecausethismeasureappliestodischargestonon‐acutecaresettings.









Result:Theresultisexpressedasarate.

MeasureQualifications:Pleasenote:ThemeasurestewardagestratificationisbasedonMedicareagegroupings.ThishasbeenadjustedtofollowtheMedicaidAdultCodeagecategories.TheunplannedinputfilesusedwereobtainedfromtheYaleGroup’sSASprogrampackage(2013SASpack)madeavailabletothepublic.



Thefollowinglink(s)maybeusedtoobtainadditionalinformationregardingtheoriginalmeasurespecificationandriskstandardizationmethodology.Thisisprovidedwithoutassurances.







TBDAbsoluteITGValue:

TBDAttributionDate:


IndexdischargeClaimType(s):

01,14







ProjectTitle:Project17–PatientsReceiveRecommendedCareforCommunity‐AcquiredPneumonia

ProjectCode:17.6

PaymentMethod:P4P


UniversalCode:44




Measure:

AdherencetoChronicMedicationsforPeoplewithDiabetesMellitus:HypoglycemicAgents

DSRIP#:97

MeasureDescription:Thepercentageofeligiblepatientswhohadatleasttwoprescriptionsforinsulinoranoraldiabeticmedicationoratleasttwoprescriptionsformultipleagentswithinananti‐diabeticclassandthathaveaProportionofDaysCovered(PDC)ofatleast0.8foratleast1anti‐diabeticclassduringthemeasurementyear.DataSource:

MMISNQF#:

2468

MeasureSteward:CMS

MeasureStewardVersion:2013,v4.0

MeasureCalculationDescriptionNumerator:Patientswithatleasttwoprescriptionsforanoraldiabeticmedication(AppendixA‐240),inanyanti‐diabeticclass,withaProportionofDaysCovered(PDC)ofatleast0.8foratleastoneanti‐diabeticclass.ProportionofDaysCovered(PDC)‐ThePDCisthesumofthedayscoveredbythedays’supplyofalldrugclaimsineachrespectivedrugclass.TheperiodcoveredbythePDCstartsonthedaythefirstprescriptionisfilled(indexdate)andlaststhroughtheendofthemeasurementperiod.Forprescriptionswithadays’supplythatextendsbeyondthemeasurementperiod,onlythedaysforwhichthedrugwasavailabletotheindividualwillbecountedduringthemeasurementperiod.Ifthereareprescriptionsforthesamedrug(genericname)onthesamedateofservice,theprescriptionwiththelargestdays’supplywillberetained.Ifprescriptionsforthesamedrug(genericname)overlap,thentheprescriptionstartdatewillbeadjustedtobethedayafterthepreviousfillhasended.



Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatients18yearsorolderwithdiabetesmellitus(AppendixA‐235)andatleasttwoprescriptionsforanoraldiabeticmedication(RefertoAppendixA‐240forNDCcodes)oratleasttwoprescriptionsformultipleagentswithinananti‐diabeticclass(RefertoAppendixA‐241forNDCcodes.Patientswithdiabetesmellitusareidentifiedusingdiagnosiscodesand/orpharmacydatawithintheinpatientoroutpatientclaimsdata.Onlyonemethodtoidentifypatientsisneededtobeincludedinthedenominator.Claimsdata.

a. Patientswithatleasttwoencounterswithaprincipalorsecondarydiagnosisofdiabetes(AppendixA‐235)withdifferentdatesofserviceinanoutpatientsettingornon‐acuteinpatient(AppendixA‐236)settingduringthemeasurementyear.

b. Patientswithatleastoneencounterwithaprincipalorsecondarydiagnosisofdiabetes(AppendixA‐235)inanacuteinpatientoremergencydepartment(AppendixA‐237)settingduringthemeasurementyear.

Pharmacydata.

a. Patientswithatleastoneambulatoryprescriptionclaimforinsulinorotheranti‐diabeticmedicationdispensedduringthemeasurementperiod.(RefertoAppendixA‐241foralistofNDCcodes).

Exclusion(s):

1. Diagnosisactivegestationaldiabetes(AppendixA‐239).2. Diagnosisactivesteroidinduceddiabetes(AppendixA‐239).3. Diagnosisactivepolycysticovaries(AppendixA‐239).

Result:Theresultisexpressedasapercentage.ImprovementDirection:Higher.



http://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/QualityMeasures/index.html?redirect=/QUALITYMEASURES/





SettingofCare:Multi‐setting




ClaimType(s):

01,03,04,12,14,15,18






Thepatientistobecontinuouslyenrolledforthemeasurementyearwithnomorethana45daygapduringtheyear.




PaymentMethod:P4P



PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

AdherencetoChronicMedicationsforPeoplewithDiabetesMellitus:Statins

DSRIP#:96

MeasureDescription:ThepercentageofeligiblepatientswhohadatleasttwoprescriptionsforstatinsandwhohadaProportionofDaysCovered(PDC)ofatleast0.8duringthemeasurementyear(12months).DataSource:

MMISNQF#:

0545

MeasureSteward:CMS

MeasureStewardVersion:2013,v4.0

MeasureCalculationDescriptionNumerator:PatientswithatleasttwoprescriptionsforstatinswithaProportionofDaysCovered(PDC)ofatleast0.8forstatins.(RefertoAppendixA‐117forNDCcodes).PDCCalculation:PDCNumeratorThePDCisthesumofthedayscoveredbythedays’supplyofalldrugclaimsineachrespectiveprescriptiondrugclass.TheperiodcoveredbythePDCstartsonthedaythefirstprescriptionisfilled(indexdate)andlaststhroughtheendofthemeasurementperiod.Forprescriptionswithadays’supplythatextendsbeyondthemeasurementperiod,onlythedaysforwhichthedrugwasavailabletotheindividualwillbecountedduringthemeasurementperiod.Ifthereareprescriptionsforthesamedrug(genericname)onthesamedateofservice,theprescriptionwiththelargestdays’supplywillberetained.Ifprescriptionsforthesamedrug(genericname)overlap,thentheprescriptionstartdatewillbeadjustedtobethedayafterthepreviousfillhasended.PDCDenominatorThePDCdenominatoristhenumberofdaysfromthefirstprescriptiondrugclaimdatethroughtheendofthemeasurementperiod,ordeathdate,whichevercomesfirst.

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatients18yearsandolder(atthebeginningofthemeasurementperiod)withdiabetesmellitusandatleasttwoprescriptionsforstatinsduringthemeasurementyear.(RefertoAppendixA‐117forNDCcodes).Patientswithdiabetesmellitus(AppendixA‐235)areidentifiedusingdiagnosiscodesand/orpharmacydatawithintheinpatientoroutpatientclaimsdata.Onlyonemethodtoidentifypatientsisneededtobeincludedinthedenominator.Claimsdata.

a. Patientswithatleasttwoencounterswithaprincipalorsecondarydiagnosisofdiabetes(AppendixA‐235)withdifferentdatesofserviceinanoutpatient



settingornon‐acuteinpatient(AppendixA‐236)settingduringthemeasurementyear.

b. Patientswithatleastoneencounterwithaprincipalorsecondarydiagnosisofdiabetes(AppendixA‐235)inanacuteinpatientoremergencydepartment(AppendixA‐237)settingduringthemeasurementyear.

Pharmacydata.

a. Patientswithatleastoneambulatoryprescriptionclaimforinsulinorotheranti‐diabeticmedicationdispensedduringthemeasurementperiod.(RefertoAppendixA‐238foralistofNDCcodes).

Exclusion(s).

1. Exclusion(s):Individualswithadiagnosisofpolycysticovarieswhodonothaveavisitwithadiagnosisofdiabetesinanysettingduringthemeasurementperiod.(AppendixA‐239).

2. Individualswithadiagnosisofgestationaldiabetesorsteroid‐induceddiabeteswho

donothaveavisitwithadiagnosisofdiabetesmellitusinanysettingduringthemeasurementperiod.(AppendixA‐239).




http://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/QualityMeasures/index.html?redirect=/QUALITYMEASURES/





Multi‐settingReportingPeriod:




01,03,04,12,14,15,18










PaymentMethod:P4P



PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

AdolescentWell‐CareVisit

DSRIP#:5

MeasureDescription:Thepercentageofenrolledmembers12–21yearsofagewhohadatleastonecomprehensivewell‐carevisitwithaPCPoranOB/GYNpractitionerduringthemeasurementyear.DataSource:

MMISNQF#:

NA

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Atleastonecomprehensivewell‐carevisitwithaPCPoranOB/GYNpractitionerduringthemeasurementyear.[Well‐CareVisit–AppendixA‐145]

Preventiveservicesmayberenderedonvisitsotherthanwell‐childvisits.Well‐childpreventiveservicescounttowardthemeasure,regardlessoftheprimaryintentofthevisit,butservicesthatarespecifictoanacuteorchronicconditionwillnotcounttowardthemeasure.

Denominator:

Ofthehospital’sattributableNewJerseyLowIncomepopulation,thoseage12‐21yearsasofDecember31ofthemeasurementyear.

Exclusions:

1. DonotincludeservicesrenderedduringaninpatientorEDvisit.



Multiplevisitsperuniquepatientwillnotbecounted.

http://www.ncqa.org/hedis‐quality‐measurement/hedis‐measures



Pleasenote:ThefollowingNewJerseyproviderspecialtieswillbeincludedasaPCP:

1. 80–FamilyPractice2. 82–NPFamily3. 110–InternalMedicine4. 370–Pediatrics5. 372–NPPediatric6. 450‐NPCommunityHealth7. 470–NPAdultHealth






ClaimType(s):

03,04,13,14,15,18





ContinuousEligibility/RiskAdjustment/SamplingMethodology Thepatientistobecontinuouslyenrolledforthemeasurementyearwithnomorethana45daygapduringtheyear.



ProjectCode:5.7


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

AdultAsthmaAdmissionRate

DSRIP#:6

MeasureDescription:Thismeasureisusedtoassessthenumberofadmissionsforasthmainadultsper1,000,ages18andolder

DataSource:MMIS

NQF#:Basedon0283(PQI15)

MeasureSteward:AHRQ

MeasureStewardVersion:October2016,Version6July2017

MeasureCalculationDescriptionNumerator:Alldischargesforpatientsages18yearsandolderwithaprincipalICD‐9‐CMorICD‐10‐CMdiagnosisofasthma.[AppendixA‐146]Exclusion(s):

1. Any‐listedICD‐9‐CMorICD‐10‐CMdiagnosiscodesforcysticfibrosisandanomaliesoftherespiratorysystem.(AppendixA‐147)

2. Transferfromahospital(differentfacility).((AppendixA‐119)3. TransferfromaSkilledNursingFacility(SNF)orIntermediateCareFacility(ICF).((Appendix

119)4. Transferfromanotherhealthcarefacility.(AppendixA‐119)5. Obstetricalcasesofpregnancy,childbirthandpuerperiumasidentifiedthroughMDC14.

(AppendixA‐92)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientswhoare18yearsandolder.


Theratewillbeexpressedasthenumberofadmitsper1,000ineachattributablepopulationperhospital.



Pleasenote:ThismeasurehasbeenmodifiedtoremoveconsiderationofthemetropolitanorcountyareaandinsteadwillmonitortheattributedDSRIPpopulation.

ThismeasureisbasedonaversionofPreventionQualityIndicator#15whichisincludedintheMedicaidAdultCoremeasureset.




https://www.medicaid.gov/medicaid/quality-of-care/downloads/medicaid-adult-core-set-manual.pdf https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V70/TechSpecs/PQI_15_Asthma_in_Younger_Adults_Admission_Rate.pdf






ClaimType(s):

01,14




ContinuousEligibilityPeriod:No RiskAdjustment:No Sampling:No



ProjectTitle:Project1‐Hospital‐BasedEducatorsTeachOptimalAsthmaCare

ProjectCode:1.6

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

AdultBodyMassIndex(BMI)assessment

DSRIP#:7

MeasureDescription:Thepercentageofpatients18to74yearsofagewhohadanoutpatientvisitandwhosebodymassindex(BMI)wasdocumentedduringthemeasurementyearortheyearpriortothemeasurementyear.DataSource:

MMISNQF#:

NotFound

MeasureSteward:NCQA

MeasureStewardVersion:20172018v2

MeasureCalculationDescriptionNumerator:Patientswhohadadocumentedbodymassindex(BMI)assessment.(AppendixA‐150)

Denominator:

Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsthatare18yearsasofJanuary1oftheyearpriortothemeasurementyearto74yearsasofDecember31ofthemeasurementyearandwhohadanoutpatientvisit(AppendixA‐151)duringthemeasurementyearortheyearpriortothemeasurementyear.Exclusion(s):

1. Patientswithadiagnosisofpregnancyduringthemeasurementyearortheyearpriortothemeasurementyear.(AppendixA‐50)












ClaimType(s):

01,03,04,14,15,18






Thepatientistobecontinuouslyenrolledforthemeasurementyearandtheyearpriortothemeasurementyearwithnomorethana45daygapduringtheyear.



ProjectCode:5.6


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

AmbulatoryCare–EmergencyDepartmentVisits

DSRIP#:8

MeasureDescription:Therateofemergencydepartmentvisitsperattributablepatientduringthemeasurementyear.DataSource:

MMISNQF#:

NotFound

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Emergencydepartment(ED)visitsthatdonotresultinaninpatientstay.Eachvisitwillbecountedonce,regardlessoftheintensityordurationofthevisit.MultipleEDvisitsonthesamedateofservicewillbecountedasonevisit.

CPT.UBREVENUE

(AppendixA‐155)

OR

CPTAND

POS

(APPENDIXA‐156)

(APPENDIXA‐157)

Exclusion(s):

Themeasuredoesnotincludementalhealthorchemicaldependencyservices.

CPT/PrincipalICD‐9‐CMDiagnosis/ICD‐9‐CMProcedure

(APPENDIXA‐158)

PrincipalICD‐9‐CMDiagnosisAND

SecondaryICD‐9‐CMDiagnosis

(APPENDIXA‐159)

(APPENDIXA‐160)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,allpatientsascategorizedinthefollowingagestratifications:

1. Patientsunderage652. Patients65andolder3. TotalPatients

Result:



Theresultisexpressedasarate.Theresultisexpressedasarateper1,000membermonthsforthemeasurementperiod.ImprovementDirection:Lower


Pleasenote:Themeasurestewardstratifiesagerangesintenagegroups.ThisstratificationhasbeenmodifiedtofollowthegeneralMedicaidAdultCoremeasureset.








03,04,14,15







ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:33

PaymentMethod:UPP



Measure:

AntidepressantMedicationManagement–EffectiveAcutePhaseTreatment

DSRIP#:11

MeasureDescription:Thepercentageofnewlydiagnosedandtreatedpatientswhoremainedonanantidepressantmedicationforatleast84days(12weeks).DataSource:

MMISNQF#:

0105

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientsfromthedenominatorwhohaveatleast84days(12weeks)ofcontinuoustreatmentwithanantidepressantmedicationduringthe114‐dayperiodfollowingtheIndexPrescriptionStartDate(IPSD).(RefertoAppendixA‐3fortheNDClist.)Continuoustreatmentallowsgapsinmedicationtreatmentuptoatotalof51daysduringthe231‐dayperiod.

Denominator:

Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosethatare18yearsandolderasofApril30ofthemeasurementyear,withcontinuousenrollmentof90days(3months)priortotheIndexEpisodeStartDate(IESD)through245daysaftertheIESDwithadiagnosisofdepressionandwerenewlytreatedwithanantidepressantmedication(RefertoAppendixA‐3fortheNDClist.).

Identifyallpatientswhometatleastoneofthefollowingcriteriaduringthein‐takeperiod:

1. Atleastoneprincipaldiagnosisofmajordepression(AppendixA‐161)inanoutpatient,ED(AppendixA‐155),orintensiveoutpatientorpartialhospitalizationsetting(AppendixA‐162)or(AppendixA‐163andAppendixA‐164).

2. Atleasttwovisitsinanoutpatient,ED(AppendixA‐155),intensiveoutpatientorpartialhospitalizationsetting(AppendixA‐162)or(AppendixA163andAppendixA‐164)ondifferentdatesofservicewithanydiagnosisofmajordepression(AppendixA‐161).

3. Atleastoneinpatient(acuteornonacute)(AppendixA‐165)claimwithanydiagnosisormajordepression(AppendixA‐161).

3.4. Atleastonetelephonevisit(AppendixA‐352)withanydiagnosisofmajordepression(AppendixA‐161).

Foreachpatientthatmeetsoneofthethreeabovecriteria,theIndexEpisodeStartDate(IESD)willbedetermined.ThedateoftheearliestencounterduringtheIntakePeriodwithanydiagnosisofmajordepressionwillbeidentified.IfthepatienthadmorethanoneencounterduringtheIntakePeriod,onlythefirstencounterwillbeincluded.



Intakeperiod‐Theintakeperiodisthe12monthwindowstartingonMay1oftheyearpriortothemeasurementyearandendingonApril30ofthemeasurementyear.

IndexEpisodeStartDate–TheearliestencounterduringtheIntakePeriodwithanydiagnosisofmajordepressionanda90‐dayNegativeMedicationHistory.

Foraninpatient(acuteornonacute)claim,theIESDisthedateofdischarge.

Foradirecttransfer,theIESDisthedischargedatefromthefacilitytowhichthepatientwastransferred.

Then,theIndexPrescriptionStartDate(IPSD)willbeidentified.TheIPSDisthedateoftheearliestdispensingeventforanantidepressantmedication(AppendixA‐3)duringtheperiodof30dayspriortotheIESD(inclusive)through14daysaftertheIESD(inclusive).Patientswhodidnotfillaprescriptionforanantidepressantmedicationduringtheperiodwillbeexcluded.

IndexPrescriptionStartDate–Theearliestprescriptiondispensingdateforanantidepressantmedicationduringtheperiodof30dayspriortotheIESD(inclusive)through14daysaftertheIESD(inclusive).

Then,theNegativeMedicationHistorywillbetested.Patientswhofilledaprescriptionforanantidepressantmedication90days(3months)priortotheIPSDwillbeexcluded.

NegativeMedicationHistory–Aperiodof90days(3months)priortotheIPSDwhenthepatienthadnopharmacyclaimsforeitherneworrefillprescriptionsforanantidepressantmedication.

Then,continuousenrollmentwillbetested.









Multi‐SettingReportingPeriod:




01,03,04,12,14,15,18,19






Thepatientistobecontinuouslyenrolledfor90days(3months)priortotheIndexEpisodeStartDate(IESD)through245daysaftertheIESDwithnomorethan45daysincoverage.


ProjectTitle:Project3‐IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)

ProjectCode:3.7

PaymentMethod:P4P


ProjectCode:5.11

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

AntidepressantMedicationManagement–EffectiveContinuationPhaseTreatment

DSRIP#:12

MeasureDescription:Thepercentageofnewlydiagnosedandtreatedpatientswhoremainedonanantidepressantmedicationforatleast180days(6months).DataSource:

MMISNQF#:

0105

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientsfromthedenominatorwhohaveatleast180days(6months)ofcontinuoustreatmentwithanantidepressantmedicationduringthe231‐dayperiodfollowingtheIndexPrescriptionStartDate(inclusive).(RefertoAppendixA‐3fortheNDClist.)Continuoustreatmentallowsgapsinmedicationtreatmentuptoatotalof51daysduringthe231‐dayperiod.

Denominator:

Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosethatare18yearsandolderasofApril30ofthemeasurementyear,withcontinuousenrollmentof90days(3months)priortotheIndexEpisodeStartDate(IESD)through245daysaftertheIESDwithadiagnosisofdepressionandwerenewlytreatedwithanantidepressantmedication.

Identifyallpatientswhometatleastoneofthefollowingcriteriaduringthein‐takeperiod:

1. Atleastoneprincipaldiagnosisofmajordepression(AppendixA–161)inanoutpatient,ED(AppendixA‐155),orintensiveoutpatientorpartialhospitalizationsetting(AppendixA‐162andAppendixA‐164).

2. At least two visits in an outpatient, ED (Appendix A‐155), intensive outpatient or partialhospitalizationsetting(AppendixA‐162andAppendixA‐164)ondifferentdatesofservicewithanydiagnosisofmajordepression(AppendixA‐161)

3. Atleastoneinpatient(acuteornonacute)claim(AppendixA‐165)withanydiagnosisormajordepression(AppendixA‐161)

3.4. Atleastonetelephonevisit(AppendixA‐352)withanydiagnosisofmajordepression(AppendixA‐161).

Foreachpatientthatmeetsoneofthethreeabovecriteria,theIndexEpisodeStartDate(IESD)willbedetermined.ThedateoftheearliestencounterduringtheIntakePeriodwithanydiagnosisofmajordepressionwillbeidentified.IfthepatienthadmorethanoneencounterduringtheIntakePeriod,onlythefirstencounterwillbeincluded.



Intakeperiod‐Theintakeperiodisthe12monthwindowstartingonMay1oftheyearpriortothemeasurementyearandendingonApril30ofthemeasurementyear.

IndexEpisodeStartDate–TheearliestencounterduringtheIntakePeriodwithanydiagnosisofmajordepressionanda90‐dayNegativeMedicationHistory.


Foradirecttransfer,theIESDisthedischargedatefromthefacilitytowhichthepatientwastransferred.

Then,theIndexPrescriptionStartDate(IPSD)willbeidentified.TheIPSDisthedateoftheearliestdispensingeventforanantidepressantmedication(AppendixA‐3)duringtheperiodof30dayspriortotheIESD(inclusive)through14daysaftertheIESD(inclusive).Patientswhodidnotfillaprescriptionforanantidepressantmedicationduringtheperiodwillbeexcluded.

IndexPrescriptionStartDate–Theearliestprescriptiondispensingdateforanantidepressantmedicationduringtheperiodof30dayspriortotheIESD(inclusive)through14daysaftertheIESD(inclusive).

Then,theNegativeMedicationHistorywillbetested.Patientswhofilledaprescriptionforanantidepressantmedication90days(3months)priortotheIPSDwillbeexcluded.

NegativeMedicationHistory–Aperiodof90days(3months)priortotheIPSDwhenthepatienthadnopharmacyclaimsforeitherneworrefillprescriptionsforanantidepressantmedication.

Then,continuousenrollmentwillbetested.













01,03,04,12,14,15,18,19






Thepatientistobecontinuouslyenrolledfor90days(3months)priortotheIndexEpisodeStartDate(IESD)withnomorethan45daysincoverage.



ProjectCode:3.2


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Asthmaadmissionrate

DSRIP#:13

MeasureDescription:Admissionswithaprincipaldiagnosisofasthmaper1,000,ages2–17.Excludescaseswithadiagnosiscodeforcysticfibrosisandanomaliesoftherespiratorysystem,obstetricadmissionsandtransfersfromotherinstitutions(PDI14).DataSource:

MMISNQF#:

0728

MeasureSteward:AHRQ

MeasureStewardVersion:October2016August2017version6.0

MeasureCalculationDescriptionNumerator:Alldischargesforpatientsages2through17yearswithaprincipaldiagnosiscodeofasthma(AppendixA‐146).Exclusion(s):

1. PatientswithanylistedICD‐9‐CMorICD‐10‐CMdiagnosiscodesforcysticfibrosisandanomaliesoftherespiratorysystem.(AppendixA‐147)

2. Transferfromahospital(differentfacility).(AppendixA‐119)3. TransferfromaSkilledNursingFacility(SNF)orIntermediateCareFacility(ICF).(AppendixA‐

119)4. Transferfromanotherhealthcarefacility.(AppendixA‐119)5. Obstetricalcasesofpregnancy,childbirthandpuerperiumasidentifiedthroughMDC14

(AppendixA‐92).

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsage2through17.

Result:Theresultisexpressedasarate.Theratewillbeexpressedasnumberofadmitsper1,000ineachattributablepopulationperhospital.ImprovementDirection:Lower


Pleasenote:ThismeasurehasbeenmodifiedtoremoveconsiderationofthemetropolitanorcountyareaandinsteadwillmonitortheDSRIPpopulation.

ThismeasureisbasedonthePediatricQualityIndicatormeasure#14.




https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60-ICD09/TechSpecs/PQI_14_Uncontrolled_Diabetes_Admission_Rate.pdf



1stSemi‐AnnualReport=April2ndSemi‐AnnualReport=October

ExperiencePeriod:6monthcalendarperiod


ClaimType(s):

01,14








ProjectCode:1.7

PaymentMethod:P4P

ProjectTitle:Project2‐PediatricAsthmaCaseManagementandHomeEvaluations

ProjectCode:2.7

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

AsthmainYoungerAdultsAdmission

DSRIP#:14

MeasureDescription:Admissionsforaprincipaldiagnosisofasthmaper1,000,ages18to39years.Excludesadmissionswithanindicationofcysticfibrosisoranomaliesoftherespiratorysystem,obstetricaladmissionsandtransfersfromotherinstitutions.(PQI15)DataSource:

MMISNQF#:

Basedon0283

MeasureSteward:AHRQ

MeasureStewardVersion:October2016August2017,v6.0

MeasureCalculationDescriptionNumerator:Alldischargesforpatientsage18through39yearswithaprincipalICD‐9‐CMorICD‐10‐CMdiagnosisofasthma.(AppendixA‐146)Exclusion(s):

1. Anydiagnosiscodeofcysticfibrosisandanomaliesoftherespiratorysystem(AppendixA‐147).

2. Transferfromahospital(differentfacility)(AppendixA‐119).3. Transferfromaskillednursingfacility(SNF)orintermediatecarefacility(ICF)(AppendixA‐

119).4. Transferfromanotherhealthcarefacility(AppendixA‐119).5. Obstetricalcasesofpregnancy,childbirthandpuerperiumasidentifiedthroughMDC14

(AppendixA‐92).

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsaged18through39years.


MeasureQualifications

Pleasenote:ThismeasurehasbeenmodifiedtoremoveconsiderationofthemetropolitanorcountyareaandinsteadwillmonitortheDSRIPpopulation.



ThismeasureisbasedonPreventionQualityIndicator#15whichisincludedinthe2016MedicaidAdultCoremeasureset.

MDC14wasaddedasanexclusionforDSRIP.PerAHRQ,dischargeswithaprincipaldiagnosisofCOPDareprecludedfromanassignmentofMDC14bythegroupersoftwarethatisused.However,astherearevariationsbetweenthegroupers,toensurethatobstetricaldischargesareremoved,exclusion#5wasadded.


https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60‐ICD09/TechSpecs/PQI_15_Asthma_in_Younger_Adults_Admission_Rate.pdf






01,14




ContinuousEligibilityPeriod:No RiskAdjustment:No Sampling:NoContinuousEligibility/RiskAdjustment/SamplingMethodology


ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:31

PaymentMethod:UPP



Measure:

AsthmaMedicationRatio

DSRIP#:90

MeasureDescription:Thepercentageofpatients5–64yearsofagewhowereidentifiedashavingpersistentasthmaandhadaratioofcontrollermedicationstototalasthmamedicationsof0.50orgreaterduringthemeasurementyear.DataSource:

MMISNQF#:

1800

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Thenumberofpatientswhohaveamedicationratioofcontrolledmedicationstototalasthmamedicationsof0.50orgreaterduringthemeasurementyear.Thenumeratorwillbestratifiedinthefollowingranges:

1. 5through17yearsofage2. 18through64yearsofage3. Total(sumoftheagestratifications)

Asthmamedicationratio‐willbecalculatedbycompletingthefollowingsteps:1. Foreachpatient,theunitsofcontrollermedicationsdispensedduringthemeasurementyearwillbe

counted.Eachdispensingeventisoneunit(RefertoAppendixA‐325fortheNDClist).2. Foreachpatient,theunitsofrelievermedicationsdispensedduringthemeasurementyearwillbe

counted.Eachdispensingeventisoneunit.(RefertoAppendixA‐338fortheNDClist).3. Foreachpatient,theunitswillbesummedtodeterminetheunitsoftotalasthmamedications.4. Foreachpatient,theratioofcontrollermedicationstototalasthmamedicationswillbecalculated

usingthefollowingformula:

UnitsofControllerMedicationsUnitsofTotalAsthmaMedications

OralMedicationDispensingEvent‐Oneprescriptionforanamountlasting30daysorless.Tocalculatedispensingeventsforprescriptionslongerthan30days,thedayssupplywillbedividedby30androundeddowntoconvert.Forexample,a100‐dayprescriptionisequaltothreedispensingevents(100/30=3.33,roundeddownto3).Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedateonwhichtheprescriptionisfilled.Multipleprescriptionsfordifferentmedicationsdispensedonthesamedayareassessedseparately.Ifmultipleprescriptionsforthesamemedicationaredispensedonthesameday,thedayssupplywillbesummedanddividedby30.TheDrugIDwillbeusedtodetermineiftheprescriptionsarethesameordifferent.InhalerDispensingEvent‐Eachinhaler(i.e.,canister)countsasonedispensingevent.Multipledispensingeventsofthesameordifferentmedicationareassessedseparately(evenifmedicationswerefilledonthesamedateofservice).Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedatewhentheprescriptionwasfilled



InjectionDispensingEvent‐Injectionscountasonedispensingevent.Multipledispensingeventsofthesameordifferentmedicationareassessedseparately.Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedatewhentheprescriptionwasfilled.

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatients5‐64yearsofageasofDecember31ofthemeasurementyearwithpersistentasthmawhometatleastoneofthefollowingcriteriaduringboththemeasurementyearandtheyearpriortothemeasurementyear.Thecriteriadoesnothavetobethesameacrossbothyears.

1. PatientswithatleastoneEDvisit(AppendixA‐155),withasthmaastheprincipaldiagnosis(AppendixA‐146).

2. Atleastoneacuteinpatientclaim(AppendixA‐172),withasthmaastheprincipaldiagnosis(AppendixA‐146).

3. Atleastfouroutpatientasthmavisits(AppendixA‐324)ondifferentdatesofservice,withasthmaasoneofthelisteddiagnoses(AppendixA‐146)andatleasttwoasthmamedicationdispensingevents.(RefertoAppendixA‐170326fortheNDClist)

4. Atleastfourasthmamedicationdispensingevents.(RefertoAppendixA‐326foralistofNDCcodes.)

a. Ifleukotrienemodifierswerethesoleasthmamedicationdispensedintheyear(RefertoAppendixA‐171foralistofNDCcodes)thepatientmustalsohaveatleastonediagnosisofasthma(AppendixA‐146),inanysetting,inthesameyearastheleukotrienemodifier(i.e.themeasurementyear,ortheyearpriortothemeasurementyear).

Exclusion(s):

1. Patientswhohadatleastoneencounterinanysetting,withanycodetoidentifyadiagnosisofemphysema,COPD,cysticfibrosisoracuterespiratoryfailure(AppendixA‐174).Lookasfarbackaspossibleinthepatient’shistorythroughDecember31ofthemeasurementyear.

2. Patientswhohavenoasthmacontrollerorrelievermedicationsdispensedduringthemeasurementyear.(RefertoAppendixA‐325orAppendixA‐338forNDCcodes.)














01,03,04,12,13,14,15,18










PaymentMethod:P4P



PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

BreastCancerScreening

DSRIP#:16

MeasureDescription:Thepercentageofwomen40‐69yearsofagewhohadamammogramtoscreenforbreastcancer.DataSource:

MMISNQF#:

0031,Nolongerendorsed

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhohavereceivedoneormoremammogramsduringthemeasurementyearortheyearpriortothemeasurementyear.Awomanhadamammogramifasubmittedclaimcontainsanycode.(AppendixA‐120)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsage40‐69asofDecember31ofthemeasurementyear.Exclusion(s):Womenwhohadabilateralmastectomy.Lookforevidenceofabilateralmastectomyasfarbackaspossibleinthepatient’shistorythroughDecember31ofthemeasurementyear.(AppendixA‐126).Anyofthefollowingmeetcriteriaforbilateralmastectomy:

a. Abilateralmastectomycode.(AppendixA‐121)b. Aunilateralmastectomycodewithabilateralmodifier.(AppendixA‐122andAppendixA‐123)

c. Twounilateralmastectomycodesondifferentdatesofservice.(AppendixA‐122andAppendixA‐124)or(AppendixA‐122andAppendixA‐125)

d. Aunilateralmastectomycodewitharightsidemodifier(AppendixA‐122andAppendixA‐124)andaunilateralmastectomycodewithaleftsidemodifier(AppendixA‐122andAppendixA‐125)(maybeonthesamedateofservice).













01,03,04,14,15,18






Thepatientmustbecontinuouslyeligibleforthemeasurementyearandtheyearpriortothemeasurementyearwithnomorethana45daygapduringeachyearofcontinuousenrollment.


ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:16




Measure:

CD4T‐CellCount

DSRIP#:20

MeasureDescription:ThepercentageofpatientswithHIVinfectionwhohad2ormoreCD4T‐cellcountsperformedinthemeasurementyear.DataSource:

MMISNQF#:

NotFound

MeasureSteward:HRSA

MeasureStewardVersion:July2008

MeasureCalculationDescriptionNumerator:ThenumberofHIV‐infectedpatientswhohad2ormoreCD4T‐cellcountsperformedatleast3monthsapartduringthemeasurementyear.(AppendixA‐153)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thoseHIV‐infectedpatients(AppendixA‐154)whohadamedicalvisit(AppendixA‐357)withaproviderwithprescribingprivileges,(i.e.MD,NP)atleastonceduringthemeasurementyear.Exclusion(s):

1. Patientsnewlyenrolledincareduringthelastsixmonthsoftheyear.




http://hab.hrsa.gov/deliverhivaidscare/files/habgrp1pms08.pdf

Thismeasureisnolongermaintainedbythesteward.








01,03,04,13,14,15,16,18




ContinuousEligibilityPeriod:Yes RiskAdjustment: No Sampling:No




ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:21




Measure:

CervicalCancerScreening

DSRIP#:22

MeasureDescription:Thepercentageofwomen24‐64yearsofagewhoreceivedoneormorePAPteststoscreenforcervicalcancer.DataSource:

MMISNQF#:

0032

MeasureSteward:NCQA

MeasureSteward Version:20172018

MeasureCalculationDescriptionNumerator:PatientswhohavereceivedoneormorePaptestsduringthemeasurementyearorthetwoyearspriortothemeasurementyear.ApatienthadaPaptestifasubmittedclaimcontainsanycode(AppendixA‐166).

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosewomenaged24‐64yearsasofDecember31ofthemeasurementyear.Exclusion(s):

1. Womenwhohadahysterectomywithnoresidualcervix(AppendixA‐167).Lookasfarbackaspossibleinthepatient’shistoryforevidenceofahysterectomythroughDecember31ofthemeasurementyear.













01,03,04,14,15,18








ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:24




Measure:

ChildImmunizationStatus

DSRIP#:25

MeasureDescription:Thepercentageofchildren2yearsofagewhohadfourdiphtheria,tetanusandacellularpertussis(Dtap);threepolio(IPV);onemeasles,mumpsandrubella(MMR);threeHinfluenzatypeB(HiB);threehepatitisB(HepB),onechickenpox(VZV);fourpneumococcalconjugate(PCV);onehepatitisA(HepA);twoorthreerotavirus(RV);andtwoinfluenza(flu)vaccinesbytheirsecondbirthday.Themeasurecalculatesarateforeachvaccineandnineseparatecombinationrates.DataSource:

MMISNQF#:

Basedon0038

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:

Combination DTaP IPV MMR HiB HepB VZV PCV HepA RV Influenza

Combination2 Combination3 Combination4 Combination5 Combination6 Combination7 Combination8 Combination9 Combination10

ForMMR,hepatitisB,VZVandhepatitisA,countanyofthefollowing:Evidenceoftheantigenorcombinationvaccine,or

ForDTaP,IPV,HiB,pneumococcalconjugate,rotavirusandinfluenza,countonlyevidenceoftheantigenorcombinationvaccine.

Forcombinationvaccinationsthatrequiremorethanoneantigen(i.e.,DTaPandMMR),evidenceofalltheantigens.

1. DTaP‐AtleastfourDTaPvaccinations,withdifferentdatesofserviceonorbeforethechild’ssecondbirthday.Avaccinationadministeredpriorto42daysafterbirthwillnotbecounted.(AppendixA‐168)

2. IPV‐AtleastthreeIPVvaccinations,withdifferentdatesofserviceonorbeforethechild’s

secondbirthday.IPVadministeredpriorto42daysafterbirthwillnotbecounted.(AppendixA‐169)

3. MMR‐AtleastoneMMRvaccination,withadateofservicefallingonorbefore

thechild’ssecondbirthday.(AppendixA‐328)



4. HiB‐AtleastthreeHiBvaccinations,withdifferentdatesofserviceonorbeforethechild’ssecondbirthday.HiBadministeredpriorto42daysafterbirthwillnotbecounted.(AppendixA‐327)

5. HepatitisB‐AtleastthreehepatitisBvaccinations,withdifferentdatesofserviceonorbeforethechild’ssecondbirthday.(AppendixA‐181)

5. VZV‐AtleastoneVZVvaccination,withadateofservicefallingonorbeforethechild’s

secondbirthday.(AppendixA‐183)

6. Pneumococcalconjugate‐Atleastfourpneumococcalconjugatevaccinations,withdifferentdatesofserviceonorbeforethechild’ssecondbirthday.Avaccinationadministeredpriorto42daysafterbirthwillnotbecounted.(AppendixA‐184)

7. HepatitisA‐AtleastonehepatitisAvaccination,withadateofservicefallingonor

beforethechild’ssecondbirthday.(AppendixA‐175)

8. Rotavirus‐Thechildmustreceivetherequirednumberofrotavirusvaccinationsondifferentdatesofserviceonorbeforethesecondbirthday.Avaccinationadministeredpriorto42daysafterbirthwillnotbecounted.Thefollowingvaccinecombinationsarecompliant:

a. Twodosesofthetwo‐dosevaccine,

b. Onedoseofthetwo‐dosevaccineandtwodosesofthethree‐dosevaccine,or

c. Threedosesofthethree‐dosevaccine.

d. ThevaccinesareidentifiedbydifferentCPTcodes(AppendixA‐176)

9. Influenza‐Atleasttwoinfluenzavaccinations,withdifferentdatesofserviceonorbeforethechild’ssecondbirthday.Avaccinationadministeredpriortosixmonths(180days)afterbirthwillnotbecounted.(AppendixA‐177)



Denominator:Ofthehospital’sNewJerseyLowIncomepopulation,thosepatientswhoturn2yearsofageduringthemeasurementyear.Exclusion(s):

1. Childrenwhohadacontraindicationforaspecificvaccinefromthedenominatorforallantigenratesandthecombinationrates.Thedenominatorforallratesmustbethesame.Excludecontraindicatedchildrenonlyiftheadministrativedatadonotindicatethatthecontraindicatedimmunizationwasrenderedinitsentirety.

Theexclusionmusthaveoccurredbythesecondbirthday.Lookforexclusionsasfarbackaspossibleinthemember’shistoryandusethecodesin(AppendixA‐178)or(AppendixA‐179andAppendixA‐180)toidentifyallowableexclusions.

Result:Theresultisexpressedasarate.Combination1calculatesarateforeachvaccine.Combination2‐9calculatesaseparaterateforpatientswhoreceivedacombinationvaccine.ImprovementDirection:Higher

MeasureQualifications:Combination1calculatesarateforeachvaccine.Combination2–9calculatesaseparaterateforpatientswhohavereceivedacombinationofvaccines.

Pleasenote:ThemeasurespecificationwasadjustedtoremovethecriteriathatallowsfordocumentedhistoryofanillnessoraseropositivetestresulttobecountedforMMR,hepatitisB,VZVandhepatitisA.Thisadjustmentallowstheremainingdatatobecollectedthroughadministrativeclaimsdata.







SettingofCare:Multi‐Setting




ClaimType(s):

1,3,4,6,12,13,14,15,18






Apatientmustbecontinuouslyenrolledforthetwelvemonthspriortothechild’ssecondbirthdaywithnomorethana45daygapduringthemeasurementperiod.


ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:26




Measure:

ChildrenandAdolescents’AccesstoPrimaryCarePractitioners

DSRIP#:27

MeasureDescription:Thepercentageofmembers12months–19yearsofagewhohadavisitwithaprimarycarephysician(PCP).

Children12–24monthsand25months–6yearswhohadavisitwithaPCPduringthemeasurementyear.Children7–11yearsandadolescents12–19yearswhohadavisitwithaPCPduringthemeasurementyearortheyearpriortothemeasurementyear.

DataSource:

MMISNQF#:

NotFound

MeasureSteward:NCQA



For12–24months,25months–6years:OneormorevisitswithaPCPduringthemeasurementyear.(AppendixA‐214andAppendixA‐215)

For7–11years,12–19years:OneormorevisitswithaPCPduringthemeasurementyearortheyearpriortothemeasurementyear.(AppendixA‐214andAppendixA‐215))PrimaryCarePhysician(PCP)‐Aphysicianornonphysician(e.g.,nursepractitioner,physicianassistant)whooffersprimarycaremedicalservices.LicensedpracticalnursesandregisterednursesarenotconsideredPCPs.(AppendixA‐215)

Exclusion(s):

1. Excludespecialtyvisits

Denominator:OftheattributableNewJerseyLowIncomepopulation,theeligiblepatientsages12months‐19yearsasofDecember31ofthemeasurementyear.

12–24monthsasofDecember31ofthemeasurementyear.Allchildrenwhoareatleast12monthsoldbutyoungerthan25monthsoldduringthemeasurementyearwillbeincluded.

25months–6yearsasofDecember31ofthemeasurementyear.Allchildrenwhoareatleast2yearsand31daysoldbutnotolderthan6yearsduringthemeasurementyearwillbeincluded.

7‐11yearsasofDecember31ofthemeasurementyear.

12‐19yearsasofDecember31ofthemeasurementyear.





MeasureQualifications:ThefollowingNewJerseyproviderspecialtieswillbeincludedasaPCP:







ClaimType(s):

04,13,18






Forthose12‐24months,25months‐6yearsthepatientsmustbecontinuouslyeligibleforthemeasurementyearwithnomorethana45daygapduringtheyear.

Forthose7‐11years,12‐19yearsthepatientsmustbecontinuouslyeligibleforthemeasurementyearandtheyearpriortothemeasurementyearwithnomorethana45daygapduringeachyearofcontinuousenrollment.





ProjectCode:15.2



UniversalCode:28




Measure:

ChlamydiaScreeninginWomen

DSRIP#:28

MeasureDescription:Thepercentageofwomen16‐24yearsofagewhowereidentifiedassexuallyactiveandwhohadatleastonetestforchlamydiaduringthemeasurementyear.DataSource:

MMISNQF#:

0033

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhoreceivedatleastonechlamydiatestduringthemeasurementyear.Awomaniscountedashavinghadatestifshehadaclaimwithaservicedateduringthemeasurementyear(AppendixA‐208)

Denominator:Ofthehospital’sNewJerseyLowIncomepopulation,thosewomen16‐24whowereidentifiedassexuallyactive.

Sexuallyactive‐Twomethodsareusedtoidentifysexuallyactivewomen:pharmacydataandclaimsdata.Apatientwillonlybeidentifiedinonemethodtobeeligibleforthemeasure.

a. Pharmacydata‐Patientswhoweredispensedprescriptioncontraceptivesduringthemeasurementyear.(RefertoAppendixA‐209foralistofNDCcodes.)

b. Claimsdata‐Patientswhohadatleastoneclaimduringthemeasurement

year.(AppendixA‐210)

Exclusion(s):

1. Patientswhohadapregnancytestduringthemeasurementyear,followedwithinsevendays(inclusive)byeitheraprescriptionforisotretinoin(Accutane)oranx‐ray.(AppendixA‐211andAppendixA‐213)or(AppendixA‐211andRefertoAppendixA‐212foralistNDCcodes.)

Thisexclusiondoesnotapplytopatientswhoqualifyforthedenominatorbasedonservicesotherthanthepregnancytestalone.(AppendixA‐211)













ClaimType(s):

01,03,04,12,13,14,15,16,18






Thepatientmustbecontinuouslyenrolledforthemeasurementyearwithnomorethana45daygapduringtheyear.


ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:25




Measure:

ComprehensiveDiabetesCare(CDC):HemoglobinA1c(HbA1c)testing

DSRIP#:29

MeasureDescription:Thepercentageofpatients18‐75yearsofagewithdiabetes(Type1andType2)whohad:HemoglobinA1c(HbA1c)testingDataSource:

MMISNQF#:

0057

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:AnHbA1ctestperformedduringthemeasurementyear.(AppendixA‐187)

Denominator:Ofthehospital’sNewJerseyLowIncomepopulation,thosepatientsaged18‐75yearsofageasofDecember31ofthemeasurementyearwhohadadiagnosisofdiabetes(type1ortype2).(AppendixA‐28)Twomethodsareprovidedtoidentifypatientswithdiabetesduringthemeasurementyear,ortheyearpriortothemeasurementyear.

1. Pharmacydata–Patientswhoweredispensedinsulinororalhypoglycemic/antihyperglycemicsduringthemeasurementyearortheyearpriortothemeasurementyear.(RefertoAppendixA‐205forNDCcodes)

2. Claimsdata–a. Patientswhohadtwoencounters,inanoutpatientsettingornonacuteinpatient

setting(AppendixA‐206),ondifferentdatesofservice,withadiagnosisofdiabetes.(AppendixA‐28)

b. PatientswhohadoneencounterinanacuteinpatientorEDsetting(AppendixA‐207),withadiagnosisofdiabetes(AppendixA‐28),duringthemeasurementyearortheyearpriortothemeasurementyear.Servicesmaybecountedoverbothyears.

Exclusion(s):1. Diagnosisofactivepolycysticovaries.(AppendixA‐91)2. Diagnosisofactivegestationaldiabetes.(AppendixA‐91)3. Diagnosisofactivesteroidinduceddiabetes.(AppendixA‐91)













ClaimType(s):

01,03,04,12,13,14,15,16,18





ContinuousEligibility/RiskAdjustment/Sampling Methodology




ProjectCode:11.4



ProjectCode:12.4


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

COPDAdmissionRate

DSRIP#:32

MeasureDescription:Thismeasureisusedtoassessthenumberofadmissionsforchronicobstructivepulmonarydisease(COPD)patient’sage18yearsandolderper1,000oftheattributablepopulation.Excludesobstetricadmissionsandtransfersfromotherinstitutions(PQI5).DataSource:

MMISNQF#:

Basedon0275

MeasureSteward:AHRQ

MeasureStewardVersion:October2016July2017v6.0

MeasureCalculationDescriptionNumerator:Allnon‐maternaldischargesforpatientsage18yearsandolderwithICD‐9‐CMprincipaldiagnosiscodeforCOPD(AppendixA‐118)orPrincipal(AppendixA‐185)andSecondary(AppendixA‐118)Exclusion(s):



(AppendixA‐92)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsage18yearsandolder.


MeasureQualifications:Pleasenote:ThismeasurehasbeenmodifiedtoremoveconsiderationofthemetropolitanorcountyareaandinsteadwillmonitortheattributedDSRIPpopulation.

ThismeasurewasbasedonPreventionQualityIndicator#5.





https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60‐ICD09/TechSpecs/PQI_05_Chronic_Obstructive_Pulmonary_Disease_(COPD)_or_Asthma_in_Older_Adults_Admission_Rate.pdf .






01,14




RiskAdjustment:No Sampling:No



ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:34

PaymentMethod:UPP



Measure:

DiabetesLong‐TermComplicationsAdmissionRate

DSRIP#:34

MeasureDescription:Admissionswithaprincipaldiagnosiscodeofdiabeteswithlong‐termcomplications(renal,eye,neurological,circulatory,orcomplicationsnototherwisespecified)per1,000,ages18yearsandolder.Excludesobstetricadmissionsandtransfersfromotherinstitutions.(PQI3)DataSource:

MMISNQF#:

Basedon0274

MeasureSteward:AHRQ

MeasureStewardVersion:October2016July2017,v6.0

MeasureCalculationDescriptionNumerator:Alldischargesforpatientsage18yearsandolderwithaprincipalICD‐9‐CMorICD‐10‐CMdiagnosiscodefordiabeteslong‐termcomplications(renal,eye,neurological,circulatory,orcomplicationsnototherwisespecified).(AppendixA‐182)Exclusion(s):1. Transferfromahospital(differentfacility).(AppendixA‐119)2. TransferfromaSkilledNursingFacility(SNF)orIntermediateCareFacility(ICF).(AppendixA‐


(AppendixA‐92)



Theratewillbeexpressedasthenumberofadmitsper1,000ineachattributablepopulationperhospital.


MeasureQualifications:Pleasenote:ThismeasurehasbeenmodifiedfromthestewardspecificationtoonlycollectinformationregardingtheattributedDSRIPpopulation.

ThismeasurewasbasedonPreventionQualityIndicator#3.



MDC14wasaddedasanexclusionforDSRIP.PerARHQ,dischargeswithaprincipaldiagnosisofdiabeteswithlong‐termcomplicationsareprecludedfromanassignmentofMDC14bythegroupersoftwarethatisused.However,astherearevariationsbetweengroupers,toensurethatobstetricaldischargesareremoved,exclusion#4wasadded.


https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60-ICD09/TechSpecs/PQI_03_Diabetes_Long-term_Complications_Admission_Rate.pdf






01,14








ProjectCode:11.9

PaymentMethod:P4P


ProjectCode:12.9

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

DiabetesMonitoringforPeoplewithDiabetesandSchizophrenia

DSRIP#:92

MeasureDescription:Thepercentageofpatients18‐64withschizophreniaanddiabeteswhohadbothanLDL‐CtestandanHb1A1ctestduringthemeasurementyear.DataSource:

MMISNQF#:

1934

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:PatientswhohadanLDL‐CtestandanHbA1ctestperformedduringthemeasurementyear.Thepatientmusthavehadbothteststobeincludedinthenumerator.(AppendixA‐330andAppendixA‐312)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsaged18‐64asofDecember31ofthemeasurementyeardiagnosedwithschizophreniaanddiabetes.Patientswithschizophreniawillbeidentifiedasthosewhomeetthefollowingcriteria:

1. PatientswhohavehadatleastoneacuteinpatientclaimAppendixA‐331)withanydiagnosisofschizophrenia(AppendixA‐332).

2. Patientswhohavehadatleasttwooutpatient,intensiveoutpatient,partialhospitalization,EDornonacuteinpatientsetting(AppendixA‐333)OR(AppendixA‐334)OR(AppendixA‐335)ondifferentdatesofservice,withanydiagnosisofschizophreniaAppendixA‐332).



Ofthosepatientsdiagnosedwithschizophrenia,thosewhoalsohavediabeteswillbeidentifiedasthosewhomeetthefollowingcriteria:

1. Pharmacydata‐Patientswhoweredispensedinsulinororalhypoglycemic/antihyperglycemicsduringthemeasurementyearoryearpriortothemeasurementyear..(RefertoAppendixA‐336forNDCcodes)

2. Claimdata‐a. Patientswhohadtwoface‐to‐faceencountersinanoutpatientsettingornonacute

inpatientsetting(AppendixA‐173)OR(AppendixA‐313),ondifferentdatesofservice,withadiagnosisofdiabetesAppendixA‐28)duringthemeasurementyearortheyearpriortothemeasurementyear.Servicesthatoccurredoverbothyearswillbecounted.

b. Patientswhohadoneface‐to‐faceencounterinanacuteinpatientsettingorEDsetting(AppendixA‐172)OR(AppendixA‐155),withadiagnosisofdiabetesAppendixA‐28)duringthemeasurementyearortheyearpriortothemeasurementyear.

Exclusion(s):

1. Patientswithgestationaldiabetes.(AppendixA‐314)2. Patientswithsteroid‐induceddiabetes.(AppendixA‐314)3. Patientswithadiagnosisofpolycysticovaries.(AppendixA‐314)













ClaimType(s):

01,03,04,12,13,14,15,18,19








ProjectTitle:Project3–IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)


PaymentMethod:P4P



PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Diabetesscreeningforpeoplewithschizophreniaorbipolardisorderwhoareusingantipsychoticmedications(SSD)

DSRIP#:35

MeasureDescription:

Thepercentageofpatients18–64yearsofagewithschizophreniaorbipolardisorder,whoweredispensedanantipsychoticmedicationandhadadiabetesscreeningtestduringthemeasurementyear.DataSource:

MMISNQF#:

1932

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:PatientsfromthedenominatorwhohavereceivedaglucosetestAppendixA‐186)oranHbA1ctestAppendixA‐187)performedduringthemeasurementyear.

Denominator:Step1:Ofthehospital’sNewJerseyLowIncomepopulation,thosepatientsage18‐64yearswithschizophreniaorbipolardisorderwhomeetatleastoneofthefollowingcriteria:

1. Patientswhohavehadatleastoneacuteinpatientclaim(AppendixA‐190)or(AppendixA‐191andAppendixA‐192)withanydiagnosisofschizophreniaAppendixA‐188)orbipolardisorderAppendixA‐189).

2. Patientswhohavehadatleasttwovisitsinanoutpatient,intensiveoutpatient,partialhospitalization(AppendixA‐193)or(AppendixA‐194andAppendixA‐195),ED(AppendixA‐196)or(AppendixA‐197andAppendixA‐157)ornonacuteinpatientsettingAppendixA‐198)or(AppendixA‐199andAppendixA‐200),ondifferentdatesofservice,withanydiagnosisofschizophreniaAppendixA‐188).

3. Patientswhohavehadatleasttwovisitsinanoutpatient,intensiveoutpatient,partialhospitalization(AppendixA‐193)or(AppendixA‐194andAppendixA‐195),ED(AppendixA‐196)or(AppendixA‐197andAppendixA‐157)ornonacuteinpatientsetting(AppendixA‐198)or(AppendixA‐199andAppendixA‐200),ondifferentdatesofservice,withanydiagnosisofbipolardisorder(AppendixA‐189)

Exclusion(s):

Step2:IdentifypatientsfromStep1whoalsohavediabetes.

Patientswithdiabetes.Therearetwowaystoidentifypatientswithdiabetes:bypharmacydataandbyclaimdata.Bothmethodsareusedtoidentifypatientswithdiabetes,butapatientneedonlytobeidentifiedbyonemethodtobeexcludedfromthemeasure.Patientsmaybeidentifiedashavingdiabetesduringthemeasurementyearortheyearpriortothemeasurementyear.



a. Pharmacydata‐Patientswhoweredispensedinsulinororalhypoglycemics/antihyperglycemicsduringthemeasurementyearoryearpriortothemeasurementyearonanambulatorybasis.(RefertoAppendixA‐43forNDCcodes.)

b. Claimdata‐

i. Patientswhohadtwoface‐to‐faceencountersinanoutpatientsetting(AppendixA‐201ornonacuteinpatientsettingAppendixA‐202),ondifferentdatesofservice,withadiagnosisofdiabetes.(AppendixA‐28)

ii. Patientswithoneface‐to‐faceencounterinanacuteinpatient(AppendixA‐172)orED(AppendixA‐196)setting,duringthemeasurementyear,ortheyearpriortothemeasurementyear.Servicesthatoccuroverbothyearswillbecounted.

iii. Patientswhohadnoantipsychoticmedicationsdispensedduringthemeasurementyear.(AppendixA‐203)or(RefertoAppendixA‐204forNDCcodes.)












CY2014CY2016ClaimType(s):01,02,03,04,12,14,15,16,18,19








ProjectTitle:Project3:IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)

ProjectCode:3.3


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

DiabetesShort‐TermComplicationsAdmissionRate

DSRIP#:36

MeasureDescription:Admissionsforaprincipaldiagnosiscodeofdiabetesshort‐termcomplications(ketoacidosis,hyperosmolarity,coma)per1,000,ages18yearsandolder.Excludesobstetricadmissionsandtransfersfromotherinstitutions.(PQI1)DataSource:

MMISNQF#:

Basedon0272

MeasureSteward:AHRQ

MeasureStewardVersion:October2016July2017v6

MeasureCalculationDescriptionNumerator:Alldischargesforpatientsage18yearsandolderwithaprincipalICD‐9‐CMorICD‐10‐CMdiagnosiscodefordiabetesshort‐termcomplications(ketoacidosis,hyperosmolarity,coma).(AppendixA‐337)Exclusion(s):



(AppendixA‐92)






Pleasenote:ThismeasurehasbeenmodifiedtoremoveconsiderationofthemetropolitanorcountyandinsteadwillmonitortheattributedDSRIPpopulation.

ThismeasureisbasedonthePreventionQualityIndicator#1.

MDC14wasaddedasanexclusionforDSRIP.PerARHQ,dischargeswithaprincipaldiagnosisofdiabeteswithlong‐termcomplicationsareprecludedfromanassignmentofMDC14bythegroupersoftwarethatisused.However,astherearevariationsbetweengroupers,toensurethatobstetricaldischargesareremoved,exclusion#4wasadded.


https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60-ICD09/TechSpecs/PQI_01_Diabetes_Short-term_Complications_Admission_Rate.pdf






01,14








ProjectCode:11.6

PaymentMethod:P4P

Project12‐DiabetesGroupVisitsforPatientsandCommunityEducation

12.7 P4P


UniversalCode:32

PaymentMethod:UPP



Measure:

Engagementofalcoholandotherdrugtreatment

DSRIP#:38

Thepercentageofadolescentandadultpatientswithanewepisodeofalcoholorotherdrug(AOD)dependencewhoinitiatedAODtreatmentandwhohadtwooradditionalserviceswithadiagnosisofAODwithin30daysoftheinitiationvisit.DataSource:

MMISNQF#:

0004

MeasureSteward:NCQA



Allpatientswhoinitiatedalcoholorotherdrug(AOD)treatmentandwhohadtwoormoreinpatientadmissions,(AppendixA‐226)oroutpatientvisits,intensiveoutpatientencounters,(AppendixA‐227)or(AppendixA‐228andAppendixA‐229)_orpartialhospitalizations(AppendixA‐230andAppendixA‐231)withanyAODdiagnosis(AppendixA‐225)within30daysafterthedateoftheInitiationencounter(inclusive).

Multipleengagementvisitsmayoccuronthesameday,buttheymustbewithdifferentprovidersinordertobecounted.

1. Forpatientswhoinitiatedtreatmentviaaninpatientstay,thedischargedatewillbeusedasthestartofthe30‐dayengagementperiod.

2. Iftheengagementencounterisaninpatientadmission,theadmissiondate(notthedischargedate)mustbewithin30daysoftheInitiationencounter(inclusive).

3. Engagementencountersthatincludedetoxificationcodes(includinginpatientdetoxification)willnotbecounted(AppendixA‐232).

Denominator:

Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsage13yearsandolderasofDecember31ofthemeasurementyearwhohadanewepisodeofAODduringtheIntakePeriod.

IntakePeriod:January1–November15ofthemeasurementyear.TheIntakePeriodisusedtocapturenewepisodesofAOD.

IndexEpisode:Theearliestinpatient,intensiveoutpatient,partialhospitalization,outpatient,detoxificationorEDencounterduringtheIntakePeriodwithadiagnosisofAOD.



Step1:ThefollowingidentifytheIndexEpisode:

1. Anoutpatientvisit,telephonevisits,intensiveoutpatientencounter(AppendixA‐227)or(AppendixA‐228andAppendixA‐229)orpartialhospitalization(AppendixA‐230andAppendixA‐231)withadiagnosisofAOD(AppendixA‐225).

2. Adetoxificationvisit(AppendixA‐232).

3. AnEDvisit(AppendixA‐233)withadiagnosisofAOD(AppendixA‐225).

4. AninpatientdischargewithadiagnosisofAODasidentifiedbyeitherofthefollowing:

a. Aninpatientfacilitycode(AppendixA‐226)inconjunctionwithadiagnosisofAOD(AppendixA‐225.

b. Aninpatientfacilitycode(AppendixA‐226)inconjunctionwithanAODprocedurecodeAppendixA‐234).

5. Atelephonevisit(AppendixA‐352)withadiagnosisofAOD(AppendixA‐225).

5. Anonlineassessment(AppendixA‐353)withadiagnosisofAOD(AppendixA‐225).

ForpatientswithmorethanoneepisodeofAOD,thefirstepisodewillbeused.

ForpatientswhosefirstepisodewasanEDvisitthatresultedinaninpatientstay,theinpatientdischargewillbeused.

Then,theearliestdateofserviceforaninpatient,intensiveoutpatient,partialhospitalization,outpatient,detoxificationorEDencounterduringtheIntakePeriodwithadiagnosisofAOD(AppendixA‐225)willbeusedastheIndexEpisodeStartDate(IESD).

Foranoutpatient,intensiveoutpatient,partialhospitalization,detoxificationorED(notresultinginaninpatientstay)claim,theIESDisthedateofservice.


ForanEDvisitthatresultsinaninpatientstay,theIESDisthedateoftheinpatientdischarge.

Fordirecttransfers,theIESDisthedischargedatefromthesecondadmission.

Step2:Then,theNegativeDiagnosisHistorywillbetested.PatientswhohadaclaimwithadiagnosisofAOD(AppendixA‐225orAppendixA‐354)oraMedicationAssistedTreatmentevent(AppendixA‐358orAppendixA‐359))duringthe60days(2months)beforetheIESDwillbeexcluded.

ForaninpatientIESD,theadmissiondatewillbeusedtodeterminetheNegativeDiagnosisHistory.

ForanEDvisitthatresultsinaninpatientstay,theEDdateofservicewillbeusedtodeterminetheNegativeDiagnosisHistory.

Fordirecttransfers,thefirstadmissionwillbeusedtodeterminetheNegativeDiagnosisHistory.

Step3:Then,continuousenrollmentwillbecalculated.













ClaimType(s):

01,03,04,14,15,18,19






Patientsmustbecontinuouslyenrolledwithoutanygaps60days(2months)beforetheIndexEpisodeStartDate(IESD)through44daysaftertheIESD.


ProjectTitle:Project9‐Hospital‐WideScreeningforSubstanceUseDisorder

ProjectCode:9.4

PaymentMethod:P4P


UniversalCode:12




Measure:

Follow‐upAfterHospitalizationforMentalIllness–30dayspostdischarge

DSRIP#:40

MeasureDescription:Thepercentageofdischargesforpatients6yearsofageandolderwhowerehospitalizedfortreatmentofselectedmentalhealthdisordersandwhohadanoutpatientvisit,anintensiveoutpatientencounterorpartialhospitalizationwithamentalhealthpractitionerwithin30daysofdischarge.DataSource:

MMISNQF#:

0576

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patients6yearsofageandolderwhoreceivedanoutpatientvisit,intensiveoutpatientencounter,orpartialhospitalization,ortransitionalcaremanagementservices.

(AppendixA‐131)OR (AppendixA‐132ANDAppendixA‐133)OR (AppendixA‐134ANDAppendixA‐135)OR (AppendixA‐355)OR (AppendixA‐136)OR (AppendixA‐137)withamentalhealthpractitioner(AppendixA‐138)within30daysafter

discharge.Outpatientvisits,intensiveoutpatientencountersorpartialhospitalizationsthatoccuronthedateofdischargewillbeincluded.

Denominator:

Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsdischargedalivefromanacuteinpatientsetting(includingacutecarepsychiatricfacilities)withaprincipalmentalillnessdiagnosis(AppendixA‐139)onorbetweenJanuary1andDecember1ofthemeasurementyearwithcontinuousenrollmentthrough30dayspostdischarge.

Onlyfacilityclaimswillbeusedtoidentifydischargeswithaprincipalmentalhealthdiagnosis.Diagnosesfromprofessionalclaimstoidentifydischargeswillnotbeused.Thedenominatorforthismeasureisbasedondischarges,notpatients.Ifpatientshavemorethanonedischarge,alldischargesonorbetweenJanuary1andDecember1ofthemeasurementyearwillbeincluded.Ifthedischargeisfollowedbyareadmissionordirecttransfertoanacutefacilityforamentalhealthprincipaldiagnosis(AppendixA‐141)OR(AppendixA‐142)withinthe30‐dayfollow‐upperiod,onlythereadmissiondischargeorthedischargefromthefacilitytowhichthepatientwastransferredwillbecounted.Althoughrehospitalizationmightnotbeforaselectedmentalhealthdisorder,itisprobablyforarelatedcondition.



Exclusion(s):

1. Dischargesfollowedbyreadmissionordirecttransfertoanonacutefacility(AppendixA‐144)foramentalhealthprincipaldiagnosis(AppendixA‐141)OR(AppendixA‐142withoutAppendixA‐222)withinthe30‐dayfollow‐upperiodwillbeexcluded.Thesedischargesareexcludedfromthemeasurebecausereadmissionortransfermaypreventanoutpatientfollow‐upvisitfromtakingplace.

2. Dischargesfollowedbyreadmissionordirecttransfertoanacuteornonacutefacilityforanon‐mentalhealthprincipaldiagnosiswithinthe30‐daypostdischargeperiodwillbeexcluded.ThisincludesanICD‐9‐CMandICD‐10‐CMDiagnosiscodeorDRGcode.Thesedischargesareexcludedfromthemeasurebecausereadmissionortransfermaypreventanoutpatientfollow‐upvisitfromtakingplace.

Result:Theresultisexpressedasapercentage.ImprovementDirectionHigher


Theagewillbecalculatedbasedonthepatient’sageasofthedateofdischarge.










CY2014CY2016ClaimType(s):01,02,03,04,06,14,15,18,19






Thepatientmustbecontinuouslyenrolledfromthedateofdischargethrough30daysafterdischargewithoutagapincoveragetobeeligible.



ProjectCode:3.1



ProjectCode:5.1


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Follow‐upAfterHospitalizationforMentalIllness–7dayspostdischarge

DSRIP#:41

MeasureDescription:Thepercentageofdischargesforpatients6yearsofageandolderwhowerehospitalizedfortreatmentofselectedmentalhealthdisordersandwhohadanoutpatientvisit,anintensiveoutpatientencounterorpartialhospitalizationwithamentalhealthpractitionerwithin7daysofdischarge.DataSource:

MMISNQF#:

0576

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patients6yearsofageandolderwhoreceivedanoutpatientvisit,intensiveoutpatientencounter,orpartialhospitalization,ortransistionalcaremanagementservices.(AppendixA‐131)OR(AppendixA‐132ANDAppendixA‐133)OR(AppendixA‐134ANDAppendixA‐135)OR(AppendixA‐356)OROR(AppendixA‐136)OR(AppendixA‐137)withamentalhealthpractitioner(AppendixA‐138)within7daysafterdischarge.Outpatientvisits,intensiveoutpatientencountersorpartialhospitalizationsthatoccuronthedateofdischargewillbeincluded.

Denominator:

Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsdischargedalivefromanacuteinpatientsetting(includingacutecarepsychiatricfacilities)withaprincipalmentalillnessdiagnosis(AppendixA‐139)onorbetweenJanuary1andDecember1ofthemeasurementyearwithcontinuousenrollmentthrough30dayspostdischarge.

Onlyfacilityclaimswillbeusedtoidentifydischargeswithaprincipalmentalhealthdiagnosis.Diagnosesfromprofessionalclaimstoidentifydischargeswillnotbeused.Thedenominatorforthismeasureisbasedondischarges,notpatients.Ifpatientshavemorethanonedischarge,alldischargesonorbetweenJanuary1andDecember1ofthemeasurementyearwillbeincluded.Ifthedischargeisfollowedbyreadmissionordirecttransfertoanacutefacilityforamentalhealthprincipaldiagnosis(AppendixA‐141)OR(AppendixA‐142)withinthe30‐dayfollow‐upperiod,onlythereadmissiondischargeorthedischargefromthefacilitytowhichthememberwastransferredwillbecounted.Althoughrehospitalizationmightnotbeforaselectedmentalhealthdisorder,itisprobablyforarelatedcondition.



Exclusion(s):

1. Dischargesfollowedbyreadmissionordirecttransfertoanonacutefacility(AppendixA‐144)foramentalhealthprincipaldiagnosis(AppendixA‐141)OR(AppendixA‐142withoutAppendixA‐222)withinthe30‐dayfollow‐upperiodwillbeexcluded.Thesedischargesareexcludedfromthemeasurebecausereadmissionortransfermaypreventanoutpatientfollow‐upvisitfromtakingplace.

Dischargesfollowedbyreadmissionordirecttransfertoanacuteornonacutefacilityforanon‐mentalhealthprincipaldiagnosiswithinthe30‐daypostdischargeperiodwillbeexcluded.ThisincludesanICD‐9‐CMorICD‐10‐CMDiagnosiscodeorDRGcode.Thesedischargesareexcludedfromthemeasurebecausereadmissionor



Theagewillbecalculatedbasedonthepatient’sageasofthedateofdischarge.











01,02,03,04,06,14,15,18,19






Thepatientmustbecontinuouslyenrolledfromthedateofdischargethrough30daysafterdischargewithoutagapincoveragetobeeligible.



ProjectCode:3.6

PaymentMethod:P4P


ProjectCode:5.8

PaymentMethod:P4P


UniversalCode:11




Measure:

Follow‐upCareforChildrenPrescribedADHDMedication

DSRIP#:42

MeasureDescription:Thepercentageofchildrennewlyprescribedattention‐deficit/hyperactivitydisorder(ADHD)medicationwhohadatleastthreefollow‐upcarevisitswithina10‐monthperiod,oneofwhichwaswithin30daysofwhenthefirstADHDmedicationwasdispensed.Tworatesarereported.InitiationPhase.Thepercentageofpatients6–12yearsofageasoftheIndexPrescriptionStartDate(IPSD)withanambulatoryprescriptiondispensedforADHDmedication,whohadonefollow‐upvisitwithapractitionerwithprescribingauthorityduringthe30‐dayInitiationPhase.ContinuationandMaintenance(C&M)Phase.Thepercentageofpatients6–12yearsofageasoftheIPSDwithanambulatoryprescriptiondispensedforADHDmedication,whoremainedonthemedicationforatleast210daysandwho,inadditiontothevisitintheInitiationPhase,hadatleasttwofollow‐upvisitswithapractitionerwithin270days(9months)aftertheInitiationPhaseended.DataSource:

MMISNQF#:

0108

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:InitiationPhase–Patientswhohavehadoneoutpatient,intensiveoutpatientorpartialhospitalizationfollow‐upvisitwithapractitionerwithprescribingauthority,within30daysaftertheIndexPrescriptionStartDate(IPSD).(AppendixA‐306)OR(AppendixA‐307)AND(AppendixA‐308)OR(AppendixA‐134)AND(AppendixA‐135).VisitsonthesamedayoftheIPSDwillnotbecounted.ContinuationandManagementPhase–PatientsmustbecompliantwiththeInitiationPhaseandhavehadatleasttwofollow‐upvisitsfrom31‐300days(10months)aftertheIPSD.(AppendixA‐306)OR(AppendixA‐307)AND(AppendixA‐308)OR(AppendixA‐134)AND(AppendixA‐135)Oneofthetwovisits(duringdays31‐300)maybeatelephonevisitwithapractitioner.(AppendixA‐319)

Continuousmedicationtreatment‐Thenumberofmedicationtreatmentdaysduringthe10‐monthfollow‐upperiodwhichmustbe≥210days(i.e.300treatmentdays–90gapdays).



Treatmentdays‐Theactualnumberofcalendardayscoveredwithprescriptionswithinthespecified300‐daymeasurementinterval(e.g.aprescriptionofa90daysupplydispensedonthe220thdaywillhave80dayscountedinthe300‐dayinterval).

Denominator:InitiationPhase–Ofthehospital’sattributableNewJerseyLowIncomepatientpopulation,thosewhoweresixyearsofageasofMarch1oftheyearpriortothemeasurementyearto12yearsasofFebruary29ofthemeasurementyearandwhowerenewlydispensedanADHDmedicationduringthe12‐monthIntakePeriod(RefertoAppendixA‐2foralistofNDCcodes.)Onlypatientswithanegativemedicationhistorywillbeincluded.TheIndexPrescriptionStartDate(IPSD)isthedispensingdateoftheearliestADHDprescriptionintheIntakePeriodwithaNegativeMedicationHistory.IntakePeriod–The12‐monthwindowstartingMarch1oftheyearpriortothemeasurementyearandendingFebruary29ofthemeasurementyear.IndexPrescriptionStartDate–TheearliestprescriptiondispensingdateforanADHDmedicationwherethedateisintheIntakePeriodandthereisaNegativeMedicationHistory.(RefertoAppendixA‐2foralistofNDCcodes.)NegativeMedicationHistory–Aperiodof120days(4months)priortotheIPSDwhenthepatienthadnoADHDmedicationsdispensedforeitherneworrefillprescriptions.(RefertoAppendixA2forNDCcodes)InitiationPhaseExclusion(s):

1. PatientswhohadanacuteinpatientclaimwithaprincipaldiagnosisorDRGformentalhealthAppendixA‐141)or(AppendixA‐321)orsubstanceabuse(AppendixA‐322)or(AppendixA‐323)duringthe300daysaftertheIPSD.

ContinuationandManagementPhase–Patientswhomeetalloftheinitiationphasenumeratoranddenominatorcriteriaandwhohaveremainedpatientswithcontinuousmedicationtreatment.Apatientmusthavefilledasufficientnumberofprescriptionstoprovidecontinuoustreatmentforatleast210daysoutofthe300‐dayperiod.Continuousmedicationtreatmentallowsforgapsinmedicationtreatmentuptoatotalof90daysduringthe300‐dayperiod.(ThisperiodspanstheInitiationPhase[1month]andtheContinuationandManagementPhase[9months].)ContinuationandManagementPhaseExclusion(s):

1. Patientsdiagnosedwithnarcolepsyatanypointintheirmedicalhistory.(AppendixA‐320)2. PatientswhohadanacuteinpatientclaimwithaprincipaldiagnosisorDRGformental

health(AppendixA‐141)or(AppendixA‐321)orsubstanceabuse(AppendixA‐322)or(AppendixA‐323)duringthe300days(10months)aftertheIPSD.





Thismeasureincludestworates.Inordertomonitorpayforperformance,theContinuationandManagementPhaseratewillapplytotheP4Pincentive.









01,03,04,12,14,15,18,19






Thepatientistobecontinuouslyenrolledfor120days(4months)priortotheIndexPrescriptionStartDate(IPSD)and30daysaftertheIPSDfortheInitiationPhase,and300days(10months)aftertheIPSDwithnomorethana45daygapfortheContinuationandManagementPhase.



ProjectCode:5.10

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

HeartFailureAdmissionRate

DSRIP#:45

MeasureDescription:Admissionswithaprincipaldiagnosisofheartfailureper1,000,ages18yearsandolder.Excludescardiacprocedureadmissions,obstetricadmissions,andtransfersfromotherinstitutions.(PQI8)DataSource:

MMISNQF#:

Basedon0277

MeasureSteward:AHRQ


MeasureCalculationDescriptionNumerator:Alldischargesforpatientsage18yearsandolderwithaprincipalICD‐9‐CMorICD‐10‐CMdiagnosiscodeforheartfailure. (AppendixA‐309)Exclusion(s):

1. Any‐listedICD‐9‐CMorICD‐10‐CMprocedurecodesforcardiacprocedure.(AppendixA‐310)2. Transferfromahospital(differentfacility).(AppendixA‐119)3. TransferfromaSkilledNursingFacility(SNF)orIntermediateCareFacility(ICF).(AppendixA‐


(AppendixA‐92)

Denominator:Ofthehospital’sattributableNewJerseyLowincomepopulation,thosepatientswhoare18yearsandolder.




ThismeasureisbasedonPreventionQualityIndicator#8.



MDC14wasaddedasanexclusionforDSRIP.PerAHRQ,dischargeswithaprincipaldiagnosisofheartfailureareprecludedfromanassignmentofMDC14bythegroupersoftwarethatisused.However,astherearevariationsbetweengroupers,toensurethatobstetricaldischargesareremoved,exclusion#5wasadded.


https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60-ICD09/TechSpecs/PQI_08_Heart_Failure_Admission_Rate.pdf






01,14





ContinuousEligibility/RiskAdjustment/Sampling Methodology



ProjectCode:6.8

PaymentMethod:P4P


ProjectCode:7.9

PaymentMethod:P4P


ProjectCode:8.9

PaymentMethod:P4P


UniversalCode:35

PaymentMethod:UPP



Measure:

HemoglobinA1c(HbA1c)TestingforPediatricPatients

DSRIP#:46

MeasureDescription:Percentageofpediatricpatients5‐17withdiabeteswhohadaHbA1ctestina12‐monthmeasurementperiod.DataSource:

MMISNQF#:

0060

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:PatientsfromthedenominatorwhohadanHbA1ctestperformedduringthemeasurementyear.(AppendixA‐312)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatients5‐17yearsofageasofDecember31ofthemeasurementyearwhohadadiagnosisofdiabetes(type1ortype2).(AppendixA‐28)Twomethodsareusedtoidentifypatientswithdiabetesduringthemeasurementyear,ortheyearpriortothemeasurementyear:pharmacyandclaimdata.Bothmethodswillbeused,butapatientonlyneedstomeetonemethodinordertobeeligibleinthedenominator.

1. Pharmacy–Patientswhoweredispensedinsulinororalhypoglycemic/antihyperglycemicsduringthemeasurementyearortheyearpriortothemeasurementyear.(RefertoAppendixA‐311forNDCcodes)

2. Claims–

a. Patientswhohadtwoencountersinanoutpatientsettingornonacuteinpatientsetting(AppendixA‐173)or(AppendixA‐313)and(AppendixA‐172),ondifferentdatesofservice,withadiagnosisofdiabetes(AppendixA‐28)duringthemeasurementyearortheyearpriortothemeasurementyear.

b. PatientswithoneencounterinanacuteinpatientorEDsetting(AppendixA‐155),withadiagnosisofdiabetes(AppendixA‐28),duringthemeasurementyearortheyearpriortothemeasurementyear.

Exclusion(s):

1. Diagnosisofactivepolycysticovaries.(AppendixA‐314)2. Diagnosisofactivegestationaldiabetes.(AppendixA‐314)3. Diagnosisofactivesteroidinduceddiabetes.(AppendixA‐314)












ImprovementTargetGoal:NA

AbsoluteITGValue:NA

AttributionDate:Lastdayofmeasurementperiod

AnchorDate:Lastdayofmeasurementperiod

ClaimType(s):

01,03,04,12,13,14,15,16,18









ProjectCode:12.5


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

HypertensionAdmissionRate

DSRIP#:48

MeasureDescription:Alldischargesofpatientsage18yearsandolderwithICD‐9‐CMorICD‐10‐CMprincipaldiagnosiscodeforhypertension.DataSource:

MMISNQF#:


MeasureSteward:AHRQ


MeasureCalculationDescriptionNumerator:Alldischargesforpatientsage18yearsandolderwithaprincipaldiagnosiscodeforhypertension.(AppendixA‐315)Exclusion(s):

1. CaseswithanydiagnosisofStageI‐IVkidneydisease(AppendixA‐316),onlyifaccompaniedbyprocedurecodeforpreparationforhemodialysis(dialysisaccessprocedures).(AppendixA‐317)

2. Caseswithacardiacprocedurecode.(AppendixA‐318)3. Transferfromahospital(differentfacility).(AppendixA‐119)4. TransferfromaSkilledNursingFacility(SNF)orIntermediateCareFacility(ICF).(AppendixA‐

119)5. Transferfromanotherhealthcarefacility.(AppendixA‐119)6. Obstetricalcasesofpregnancy,childbirthandpuerperiumthroughMDC14.(AppendixA‐92)




Pleasenote:ThismeasurehasbeenmodifiedtoremoveconsiderationofthemetropolitanorcountyareaandinsteadwillmonitortheattributableDSRIPpopulation.






https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60-ICD09/TechSpecs/PQI_07_Hypertension_Admission_Rate.pdf






01,14








ProjectCode:11.7

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Initiationofalcoholandotherdrugtreatment

DSRIP#:52

MeasureDescription:Thepercentageofadolescentandadultpatientswithanewepisodeofalcoholorotherdrug(AOD)dependencewhoinitiatetreatmentthroughaninpatientAODadmission,outpatientvisit,intensiveoutpatientencounter,orpartialhospitalizationwithin14daysofthediagnosis.DataSource:

MMISNQF#:

0004

MeasureSteward:NCQA



Allpatientswhoinitiatedalcoholorotherdrug(AOD)treatmentthroughaninpatientadmission(AppendixA‐226),outpatientvisit,intensiveoutpatientencounters(AppendixA‐227)or(AppendixA‐228andAppendixA‐229)orpartialhospitalization(AppendixA‐230andAppendixA‐231)within14daysofdiagnosis.(AppendixA‐225)

1. IftheIndexEpisodewasaninpatientdischarge,theinpatientstayisconsideredinitiationoftreatmentandthepatientiscompliant.

2. IftheIndexEpisodewasanoutpatient,intensiveoutpatient,partialhospitalization,detoxificationorEDvisit,thepatientmusthaveaninpatientadmission,outpatientvisit,intensiveoutpatientencounterorpartialhospitalizationwithanAODdiagnosiswithin14daysoftheIndexEpisodeStartDate(IESD)(inclusive).

3. Iftheinitiationencounterisaninpatientadmission,theadmissiondate(notthedischargedate)mustbewithin14daysoftheIESD(inclusive).

4. IndexEpisodesthatincludedetoxificationcodes(includinginpatientdetoxification)

(AppendixA‐232)willnotbecountedasbeinginitiationoftreatment.

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsage13yearsandolderasofDecember31ofthemeasurementyearwhohadanewepisodeofAODduringtheIntakePeriod.

IntakePeriod‐January1–November15ofthemeasurementyear.TheIntakePeriodisusedtocapturenewepisodesofAOD.

IndexEpisode‐Theearliestinpatient,intensiveoutpatient,partialhospitalization,outpatient,detoxificationorEDencounterduringtheIntakePeriodwithadiagnosisofAOD.

ForEDvisitsthatresultinaninpatientstay,theinpatientstayistheIndexEpisode.



Step1:ThefollowingidentifytheIndexEpisode

1. Anoutpatientvisit,intensiveoutpatientencounter(AppendixA‐227)or(AppendixA‐228andAppendixA‐229)orpartialhospitalization(AppendixA‐230andAppendixA‐231)withadiagnosisofAOD(AppendixA‐225).

2. Adetoxificationvisit(AppendixA‐232).

3. AnEDvisit(AppendixA‐233)withadiagnosisofAOD(AppendixA‐225).

4. AninpatientdischargewithadiagnosisofAODasidentifiedbyeitherofthefollowing:

a. Aninpatientfacilitycode(AppendixA‐226)inconjunctionwithadiagnosisofAOD(AppendixA‐225).

b. Aninpatientfacilitycode(AppendixA‐226)inconjunctionwithanAODprocedurecode(AppendixA‐234).

5. Atelephonevisit(AppendixA‐352)withadiagnosisofAOD(AppendixA‐225).

5.6. Anonlineassessment(AppendixA‐353)withadiagnosisofAOD(AppendixA‐225).

ForpatientswithmorethanoneepisodeofAOD,thefirstepisodewillbeused.

ForpatientswhosefirstepisodewasanEDvisitthatresultedinaninpatientstay,theinpatientdischargewillbeused.

Then,theearliestdateofserviceforaninpatient,intensiveoutpatient,partialhospitalization,outpatient,detoxificationorEDencounterduringtheIntakePeriodwithadiagnosisofAOD(AppendixA‐225)willbeusedastheIndexEpisodeStartDate(IESD).

Foranoutpatient,intensiveoutpatient,partialhospitalization,detoxificationorED(notresultinginaninpatientstay)claim,theIESDisthedateofservice.


ForanEDvisitthatresultsinaninpatientstay,theIESDisthedateoftheinpatientdischarge.

Fordirecttransfers,theIESDisthedischargedatefromthesecondadmission.

Step2:Then,theNegativeDiagnosisHistorywillbetested.PatientswhohadaclaimwithadiagnosisofAOD(AppendixA‐225orAppendixA‐354)oraMedicationAssistedTreatmentevent(AppendixA‐358orAppendixA‐359)duringthe60days(2months)beforetheIESDwillbeexcluded.

ForaninpatientIESD,theadmissiondatewillbeusedtodeterminetheNegativeDiagnosisHistory.

ForanEDvisitthatresultsinaninpatientstay,theEDdateofservicewillbeusedtodeterminetheNegativeDiagnosisHistory.

Fordirecttransfers,thefirstadmissionwillbeusedtodeterminetheNegativeDiagnosisHistory.

Step3:Then,continuousenrollmentwillbecalculated.Exclusion(s):



1. PatientsfromthedenominatorwhoseinitiationencounterisaninpatientstaywithadischargedateafterDecember1ofthemeasurementyearwillbeexcluded.





Themeasurestewardagestratifiestheresultsby13‐17,18+andaTotal.InordertomonitorP4P,onlytheagestratificationthatincludesallages(Total)willbeusedforDSRIP.









01,03,04,14,15,18,19






Patientsmustbecontinuouslyenrolledwithoutanygaps60days(2months)beforetheIndexEpisodeStartDate(IESD)through44daysaftertheIESD.


ProjectTitle:Project9‐Hospital‐WideScreeningforSubstanceUseDisorder

ProjectCode:9.3

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

MedicationManagementforPeoplewithAsthma–75%

DSRIP#:60

MeasureDescription:Thepercentageofpatients5‐64yearsofageduringthemeasurementyearwhowereidentifiedashavingpersistentasthmaandweredispensedappropriatemedicationsthattheyremainedonduringthetreatmentperiod.‐Thepercentageofpatientswhoremainedonanasthmacontrollermedicationforatleast75%oftheirtreatmentperiod.DataSource:

MMISNQF#:

Basedon1799

MeasureSteward:NCQA



Thenumberofpatientswhoachievedaproportionofdayscovered(PDC)ofatleast75%fortheirasthmacontrollermedicationsduringthemeasurementyear.(RefertoAppendixA‐219foralistofNDCcodes.)

Indexprescriptionstartdate(IPSD)‐Theearliestprescriptiondispensingdateforanyasthmacontrollermedicationduringthemeasurementyear.Treatmentperiod‐TheperiodoftimebeginningontheIPSDthroughthelastdayofthemeasurementyearProportionofdayscovered(PDC)‐Thenumberofdaysthatamemberiscoveredbyatleastoneasthmacontrollermedicationprescription,dividedbythenumberofdaysinthetreatmentperiod.

Calculatingnumberofdayscoveredformultipleprescriptions:

Ifmultipleprescriptionsfordifferentmedicationsaredispensedonthesameday,calculatenumberofdayscoveredbyacontrollermedication(forthenumerator)usingtheprescriptionswiththelongestdayssupply.Formultipledifferentprescriptionsdispensedondifferentdayswithoverlappingdayssupply,counteachdaywithinthetreatmentperiodonlyoncetowardthenumerator.

Ifmultipleprescriptionsforthesamemedicationaredispensedonthesameordifferentday,sumthedayssupplyandusethetotaltocalculatethenumberofdayscoveredbyacontrollermedication(forthenumerator).Forexample,threecontrollerprescriptionsforthesamemedicationaredispensedonthesameday,eachwitha30‐daysupply,sumthedayssupplyforatotalof90dayscoveredbyacontroller.

UsethedrugIDprovidedbytheNDCtodetermineiftheprescriptionsarethesameordifferent.Followthestepsbelowtoidentifynumeratorcompliance.



STEP1

IdentifytheIPSD.TheIPSDistheearliestdispensingeventforanyasthmacontrollermedication(RefertoAppendixA‐219foralistofNDCcodes)duringthemeasurementyear.STEP2Todeterminethetreatmentperiod,calculatethenumberofdaysfromtheIPSD(inclusive)totheendofthemeasurementyear.STEP3Countthedayscoveredbyatleastoneprescriptionforanasthmacontrollermedication(RefertoAppendixA‐219foralistofNDCcodes)duringthetreatmentperiod.Toensurethatthedayssupplydoesnotexceedthetreatmentperiod,subtractanydayssupplythatextendsbeyondDecember31ofthemeasurementyear.STEP4Calculatethepatient’sPDCusingthefollowingequation.

TotalDaysCoveredbyaControllerMedicationintheTreatmentPeriod(step3)──────────────────────────────────────────────────────

TotalDaysinTreatmentPeriod(step2)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatients5‐64yearsofageduringthemeasurementyearwhowereidentifiedashavingpersistentasthmaandweredispensedappropriatemedications.Patientswillbestratifiedinthefollowingranges:

1. Under18yearsofage2. 18yearsthrough64

Step1:Identifypatientsashavingpersistentasthmawhometatleastoneofthefollowingcriteriaduringboththemeasurementyearandtheyearpriortothemeasurementyear.Criterianeednotbethesameacrossbothyears:

1. AtleastoneEDvisit(AppendixA‐155),withasthmaastheprincipaldiagnosis.(AppendixA‐216)

2. Atleastoneacuteinpatientclaim(AppendixA‐172),withasthmaastheprincipaldiagnosis.(AppendixA‐216)

3. Atleastfouroutpatientasthmavisitsorobservationvisits(AppendixA‐201)ondifferentdatesofservice,withasthmaasoneofthelisteddiagnosesAppendixA‐216)andatleasttwoasthmamedicationdispensingevents.(RefertoAppendixA‐218foralistofNDCcodes)

4. Atleastfourasthmamedicationdispensingevents.(RefertoAppendixA‐218foralistof

NDCcodes)



Step2:Apatientidentifiedashavingpersistentasthmabecauseofatleastfourasthmamedicationdispensingevents,whereleukotrienemodifiers(RefertoAppendixA‐217forNDCcodes)werethesoleasthmamedicationdispensedinthatyear,mustalsohaveatleastonediagnosisofasthma(AppendixA‐216),inanysetting,inthesameyearastheleukotrienemodifier(i.e.,measurementyearoryearpriortothemeasurementyear).

Oralmedicationdispensingevent‐

Oneprescriptionofanamountlasting30daysorless.Tocalculatedispensingeventsforprescriptionslongerthan30days,dividethedayssupplyby30androunddowntoconvert.Forexample,a100‐dayprescriptionisequaltothreedispensingevents(100/30=3.33,roundeddownto3).Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedateonwhichtheprescriptionisfilled.

Multipleprescriptionsfordifferentmedicationsdispensedonthesamedayarecountedasseparatedispensingevents.Ifmultipleprescriptionsforthesamemedicationaredispensedonthesameday,sumthedayssupplyanddivideby30.UsetheDrugIDtodetermineiftheprescriptionsarethesameordifferent.

a. Twoprescriptionsfordifferentmedicationsdispensedonthesameday,eachwitha60‐daysupply,equalsfourdispensingevents(twoprescriptionswithtwodispensingeventseach).

b. Twoprescriptionsfordifferentmedicationsdispensedonthesameday,eachwitha15‐daysupply,equalstwodispensingevents(twoprescriptionswithonedispensingeventeach).

c. Twoprescriptionsforthesamemedicationdispensedonthesameday,eachwitha15‐daysupply,equalsonedispensingevent(sumthedayssupplyforatotalof30days).

d. Twoprescriptionsforthesamemedicationdispensedonthesameday,eachwitha60‐daysupply,equalsfourdispensingevents(sumthedayssupplyforatotalof120days).

Inhalerdispensingevent‐Eachinhaler(i.e.,canister)countsasonedispensingevent.Multipledispensingeventsofthesameordifferentmedicationarecountedasseparatedispensingevents(evenifmedicationswerefilledonthesamedateofservice).Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedatewhentheprescriptionwasfilled.Injectiondispensingevent‐Injectionscountasonedispensingevent.Multipledispensingeventsofthesameordifferentmedicationarecountedasseparatedispensingevents.Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedatewhentheprescriptionwasfilled.Exclusion(s):

1. Patientswithoneencounter,inanysetting,withanycodetoidentifyadiagnosisofemphysema,COPD,cysticfibrosisoracuterespiratoryfailure.(AppendixA‐174)

2. Patientswhohavenoasthmacontrollermedicationsdispensedduringthemeasurementyear.(RefertoAppendixA‐219foralistofNDCcodes)




ImprovementDirectionHigher

MeasureQualifications:Pleasenote:Themeasurestewardstratifiesthismeasureintofivecategories.ThishasbeenadjustedtotwoagecategoriestocorrespondtotheMedicaidAdultCoremeasureset.Incentivepaymentfortheprojectswillbebasedonthefollowingageranges:

1. Project1–Resultsforthosepatients18yearsthrough642. Project2–Resultsforthosepatientsunder18yearsofage









01,03,04,12,13,14,15,18






Thepatientistobecontinuouslyenrolledforthemeasurementyearandtheyearpriortothemeasurementyearwithnomorethana45daygapduringtheyear.



ProjectCode:1.4

PaymentMethod:P4P


ProjectCode:2.4

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

MentalHealthUtilization

DSRIP#:62

MeasureDescription:Thepercentageandnumberofpatientswhoutilizedmentalhealthservicescategorizedbydischarges,emergencydepartment/outpatientservicesandstratifiedbyage.DataSource:

MMISNQF#:

NotFound

MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Thepercentageandcountofuniquepatientswhoreceivedthefollowingserviceswithanymentalhealthbenefit,regardlessofthenumberofvisitsduringthemeasurementperiod.Theresultswillbestratifiedbytheseservices:

1. Inpatientmentalhealthservices.Includeinpatientcareateitherahospitalortreatmentfacility(AppendixA‐221andAppendixA‐220)withmentalhealthastheprincipaldiagnosis.

a. Excludedischargeswithprinciplediagnosisofbehavioralhealth(AppendixA‐221andA‐222).

2. EmergencyDepartmentservicesandOutpatientservicesAppendixA‐223)withaprincipalmentalhealthdiagnosisAppendixA‐220).

Forpatientswhohadmorethanonevisit,onlythefirstvisitwillbecountedinthemeasurementperiodandreportedbytherespectiveagecategory.

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thetotalpatientswithanymentalhealthbenefitduringthemeasurementperiodstratifiedintothefollowingagecategories:Stratifiedbythefollowingagegroups:

1. Below18yearsofage2. 18yearsofagethrough643. 65yearsofageandabove4. Total





Pleasenote:Themeasurestewardindicatesthatthemeasureistoreportinformationaboutintensiveoutpatientandpartialhospitalizationservices.ThiswillnotbereportedseparatelyforDSRIP.

OnlytotalcountswillbereportedasadjustedforagetoalignwiththeMedicaidAdultCoremeasureset.








01,03,04,14,15,18,19,22







ProjectTitle:Project3–IntegratedHealthHomefortheSeriouslyMentallyIll(SMI)

ProjectCode:3.5



ProjectCode:5.4



UniversalCode:2




Measure:

PercentofpatientswhohavehadavisittoanEmergencyDepartment(ED)forasthmainthepastsixmonths

DSRIP#:66

MeasureDescription:Thismeasureisusedtoassessthepercentofpatientsaged5–18or5‐64whohavehadavisittoanEmergencyDepartment(ED)forasthmainthepastsixmonths.DataSource:

MMISNQF#:

NotFound

MeasureSteward:HRSA

MeasureStewardVersion:NotFound

MeasureCalculationDescriptionNumerator:ThenumberofpatientsfromthedenominatorwhohadavisittoanEmergencyDepartment(ED)foraprincipaldiagnosisofasthmaduringthesixmonthmeasurementperiod.(AppendixA‐155)Thenumeratorwillbestratifiedinthefollowingranges:

1. 5through18yearsofage(Project2,P4P)2. 5through64yearsofage,Total(Project1,P4P)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientsaged5‐18or5‐64withanasthmadiagnosisduringthetwelvemonthspriortothesix‐monthmeasurementperiod.(AppendixA‐300)Exclusion(s):

1. Patientswithoneencounter,inanysetting,withanycodetoidentifyadiagnosisofemphysema,COPD,cysticfibrosisoracuterespiratoryfailureAppendixA‐301).






https://www.guidelinecentral.com/share/quality‐measures/27599/#h2_measure‐domain






BaselinePeriod:SAJuly‐December20142016

ClaimType(s):

01,02,03,04,05,06,09,13,14,15,16,18,19






Thepatientistobecontinuouslyenrolledforthesix‐monthmeasurementperiodwithnomorethana22daygapduringthesix‐monthmeasurementperiodandtheyearpriortothemeasurementperiodwithnomorethana45daygapduringtheyear.



ProjectCode:1.5

PaymentMethod:P4P


ProjectCode:2.5

PaymentMethod:P4P


UniversalCode:13




Measure:

PercentageofLiveBirthsWeighingLessthan2,500grams

DSRIP#:67

MeasureDescription:Lowbirthweight(<2,500grams)infantsper1,000newborns.Excludestransfersfromotherinstitutions.(PQI9)DataSource:

MMISNQF#:

Basedon0278

MeasureSteward:CDC

MeasureStewardVersion:October2016July2017

MeasureCalculationDescriptionNumerator:Numberofnewbornswithany‐listedICD‐9‐CMorICD‐10‐CMdiagnosiscodesforbirthweightlessthan2,500grams.(AppendixA‐302)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatientswhoarenewborns.

Anewbornisdefinedasanydischargemeetingthedefinitionof:

1. Any‐listedICD‐9‐CMorICD‐10‐CMcodeforin‐hospitallivebirth(AppendixA‐303)andageindaysequaltozeroormissing;or

2. Anadmissiontypeofnewborn(AdmissionType=4)andageindaysequaltozerowithoutany‐listedICD‐9‐CMorICD‐10‐CMdiagnosiscodesforout‐of‐hospitallivebirthAppendixA‐304);or

3. Anadmissiontypeofnewborn(AdmissionType=4)withpointoforiginforborninsidethishospital(AdmissionSource=5).

Exclusion(s):

1. Transferfromanotherinstitution







https://qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60‐ICD09/TechSpecs/PQI_09_Low_Birth_Weight_Rate.pdf






01,14







ProjectTitle:NA

ProjectCode:NA

PaymentMethod:NA


UniversalCode:39

PaymentMethod:UPP



Measure:

UncontrolledDiabetesAdmissionRate

DSRIP#:81

MeasureDescription:Admissionsforaprincipaldiagnosisofdiabeteswithoutmentionofshort‐term(ketoacidosis,hyperosmolarity,orcoma)orlong‐term(renal,eye,neurological,circulatory,orotherunspecified)complicationsper1,000,ages18yearsandolder.Excludesobstetricadmissionsandtransfersfromotherinstitutions.(PQI14)DataSource:

MMISNQF#:

Basedon0638

MeasureSteward:AHRQ

MeasureStewardVersion:July20176v6.0

MeasureCalculationDescriptionNumerator:Alldischargesforpatientsage18yearsandolder,withaprincipaldiagnosiscodeforuncontrolleddiabeteswithoutmentionofshort‐termorlong‐termcomplication.(AppendixA‐305)Exclusion(s):

1. Transferfromahospital(differentfacility).(AppendixA‐119)2. TransferfromaSkilledNursingFacility(SNF)orIntermediateCareFacility(ICF).(Appendix

A‐119)3. Transferfromanotherhealthcarefacility.(AppendixA‐119)4. Obstetricalcasesofpregnancy,childbirthandpuerperiumasidentifiedthroughMDC14.

(AppendixA‐92)










https://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V60-ICD09/TechSpecs/PQI_14_Uncontrolled_Diabetes_Admission_Rate.pdf






01,14








ProjectCode:11.5

PaymentMethod:P4P


ProjectCode:12.8

PaymentMethod:P4P

UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

UseofAppropriateMedicationsforPeoplewithAsthma

DSRIP#:83

MeasureDescription:Thepercentageofpatients5‐64yearsofageduringthemeasurementyearwhowereidentifiedashavingpersistentasthmaandwhowereappropriatelyprescribedmedicationduringthemeasurementyear.DataSource:

MMISNQF#:


MeasureSteward:NCQA


MeasureCalculationDescriptionNumerator:Patientswhoweredispensedatleastoneprescriptionforanasthmacontrollermedicationduringthemeasurementyear.(RefertoAppendixA‐219foralistofNDCcodes.)

Denominator:Ofthehospital’sattributableNewJerseyLowIncomepopulation,thosepatients5–64yearsofagebyDecember31ofthemeasurementyearwhowereidentifiedashavingpersistentasthma.Patientswillbestratifiedinthefollowingranges:

1. Under18yearsofage2. 18yearsthrough64

Identifypatientsashavingpersistentasthmawhometatleastoneofthefollowingcriteriaduringboththemeasurementyearandtheyearpriortothemeasurementyear.Criterianeednotbethesameacrossbothyears.

1. AtleastoneEDvisit(AppendixA‐155),withasthmaastheprincipaldiagnosis(AppendixA‐216).

2. Atleastoneacuteinpatientclaim(AppendixA‐172),withasthmaastheprincipaldiagnosis(AppendixA‐216).

3. Atleastfouroutpatientasthmavisits(AppendixA‐201)ondifferentdatesofservice,withasthmaasoneofthelisteddiagnoses(AppendixA‐216)andatleasttwoasthmamedicationdispensingevents(RefertoA‐224forNDCcodes).

4. Atleastfourasthmamedicationdispensingevents(RefertoA‐224forNDCcodes).a. Apatientidentifiedashavingpersistentasthmabecauseofatleastfourasthma

medicationdispensingevents,whereleukotrienemodifiers(RefertoA‐339forNDCcodes)werethesoleasthmamedicationdispensedinthatyear,mustalsohaveatleastonediagnosisofasthmaAppendixA‐216),inanysetting,inthesameyearastheleukotrienemodifier(i.e.,measurementyearoryearpriortothemeasurementyear).

Oralmedicationdispensingevent‐

Oneprescriptionofanamountlasting30daysorless.Tocalculatedispensingeventsforprescriptionslongerthan30days,dividethedayssupplyby30androunddowntoconvert.Forexample,a100‐dayprescriptionisequaltothreedispensingevents(100/30=3.33,roundeddownto3).Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedateonwhichtheprescriptionisfilled.



Multipleprescriptionsfordifferentmedicationsdispensedonthesamedayarecountedasseparatedispensingevents.Ifmultipleprescriptionsforthesamemedicationaredispensedonthesameday,sumthedayssupplyanddivideby30.UsetheDrugIDtodetermineiftheprescriptionsarethesameordifferent.

a. Twoprescriptionsfordifferentmedicationsdispensedonthesameday,eachwitha60‐daysupply,equalsfourdispensingevents(twoprescriptionswithtwodispensingeventseach).

b. Twoprescriptionsfordifferentmedicationsdispensedonthesameday,eachwitha15‐daysupply,equalstwodispensingevents(twoprescriptionswithonedispensingeventeach).

c. Twoprescriptionsforthesamemedicationdispensedonthesameday,eachwitha15‐daysupply,equalsonedispensingevent(sumthedayssupplyforatotalof30days).

d. Twoprescriptionsforthesamemedicationdispensedonthesameday,eachwitha60‐daysupply,equalsfourdispensingevents(sumthedayssupplyforatotalof120days).

InhalerDispensingEvent‐Eachinhaler(i.e.,canister)countsasonedispensingevent.Multipledispensingeventsofthesameordifferentmedicationarecountedasseparatedispensingevents(evenifmedicationswerefilledonthesamedateofservice).Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedatewhentheprescriptionwasfilled.InjectionDispensingEvent‐Injectionscountasonedispensingevent.Multipledispensingeventsofthesameordifferentmedicationarecountedasseparatedispensingevents.Thedispensingeventswillbeallocatedtotheappropriateyearbasedonthedatewhentheprescriptionwasfilled.

Exclusion(s):

1. Patientswhohadatleastoneencounter,inanysetting,withanycodetoidentifyadiagnosisofemphysema,COPD,cysticfibrosisoracuterespiratoryfailureAppendixA‐174).


MeasureQualifications:Pleasenote:Themeasurestewardstratifiesthismeasureintofivecategories.ThishasbeenadjustedtotwoagecategoriesthatcorrespondtotheMedicaidAdultCoremeasureset.











ClaimType(s):

01,03,04,12,13,14,15,18






Thepatientistobecontinuouslyenrolledforthemeasurementyearandtheyearpriortothemeasurementyearwithnomorethana45daygapduringeachyear.



ProjectCode:1.3


ProjectTitle:Project2–PediatricAsthmaCaseManagementandHomeEvaluations

ProjectCode:2.3


UniversalMeasure:No

UniversalCode:NA

PaymentMethod:NA



Measure:

Well‐ChildVisitsinFirst15MonthsofLife

DSRIP#:88

MeasureDescription:Thepercentageofpatientswhoturned15monthsoldduringthemeasurementyearandwhohadthefollowingnumberofwell‐childvisitswithaprimarycarephysician(PCP)(AppendixA‐215)duringtheirfirst15monthsoflife:

Nowell‐childvisits 1‐3well‐childvisits 4ormorewell‐childvisits

DataSource:

MMISNQF#:

Basedon1392

MeasureSteward:NCQA



Threeseparatenumeratorsarecalculated,correspondingtothenumberofmemberswhohad0,1‐3,4ormorewell‐childvisitswithaPCPduringtheirfirst15monthsoflife.Thewell‐childvisitmustoccurwithaPCP.(AppendixA‐145)Primarycarepractitioner(PCP)‐Aphysicianornonphysician(e.g.,nursepractitioner,physicianassistant)whooffersprimarycaremedicalservices.LicensedpracticalnursesandregisterednursesarenotconsideredPCPs.

Denominator:Ofthehospital’sNewJerseyLowIncomepopulation,thosepatients15monthsduringthemeasurementyear.The15‐monthbirthdaywillbecalculatedasthechild’sfirstbirthdayplus90days.Forexample,achildbornonJanuary9,2011,andincludedintherateof“fourormorewell‐childvisits”musthavehadfourormorewell‐childvisitsbyApril8,2012.




MeasureQualifications:ThefollowingNewJerseyproviderspecialtieswillbeincludedasaPCP:


Pleasenote:Thismeasurehasbeenadjustedfromthemeasurestewardfromsevenseparateratestothree.





OutpatientsettingReportingPeriod:




04,13,18








ProjectCode:NA

PaymentMethod:NA


UniversalCode:27
