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2008 Measurement Year /
2009 Reporting Year
Clinical Domain
Measures to be collected,
reported and recommended
for payment
&
+7 8
1. Childhood Immunization Status
w/ 24-month continuous enrollment
2. Appropriate Treatment for Children with Upper Respiratory Infection
3. Breast Cancer Screening
4. Cervical Cancer Screening
5. Chlamydia Screening in Women
6. Use of Appropriate Medication for People with Asthma
9. Cholesterol Management LDL Screening (includes Pts. w/ Cardiovascular Conditions)
10. Cholesterol Management: LDL Control <100 (includes Pts. w/ Cardiovascular Conditions)
12. Colorectal Cancer Screening
13. Appropriate Testing for Children with Pharyngitis
14. Avoidance of Antibiotic Treatment of Adults with Acute Bronchitis
15. Use of Imaging Studies for Low Back Pain
16. Medication Monitoring (ACE/ARBs, digoxin, diuretics)
3.75 Encounters per member per year (using Encounter Rate by Service Type specs)
40%
Clinical Weighting
Patient Experience
Measures to be collected,
reported and recommended
for payment
Patient Experience
Weighting
IT-Enabled Systemness
Measures to be collected,
reported and recommended
for payment
Weighting
1. Getting Appointment with a Specialist
2. Rating of Specialist
3. Timely Care and Service composite
4. Doctor-Patient Interaction composite
5. Care Coordination composite
6. Rating of PCP
7. Rating of all Healthcare
8. Office Staff composite
9. Health Promotion composite
(20% for Improvement; 80% for Attainment)
1. Data Integration for Population Management
a. Reporting Based on Electronic Information
b. Identifying Important Conditions
2. Electronic Clinical Decision Support at the Point of Care
3. Care Management
a. Coordination with Practitioners
b. Chronic Care Management
c. Continuity of Care
4. Access and Communication
a. Processes
5. Physician Measurement and Reporting
25%
15%
Coordinated Diabetes
Care
Weighting
1.
2.
3.
4.
5.
6.
7.
8.
HbA1c Screening
HbA1c Poor Control (>9)
HbA1c Control (<8)
LDL Screening
LDL Control <100
Nephropathy Monitoring
Diabetes Registry and related activities
Diabetes Care Management Program
Efficiency Domain
Generic Prescribing
Efficiency Weighting
Separate from quality incentive pool
Reportable NonPayment Measures
Measures to be Collected
and Publicly Reported, but
not recommended for
Payment
Transition Measures
Measures to be Collected but
not Publicly Reported or
recommended for Payment.
these measures have been
tested and approved for
addition to the P4P measure
set in the following year.
Testing Measures
1. Medicare Measures:
a. Breast Cancer Screening
b. Diabetes Care HbA1c Screening
c. Diabetes Care HbA1c Poor Control
d. Cholesterol Management LDL Screening (Includes Medicare Pts. w/ Cardiovascular Conditions
e. Cholesterol Management: LDL Control <100 (Includes Medicare Pts. w/ Cardiovascular Conditions
f. Nephropathy Monitoring for Diabetic Patients
g. Colorectal Cancer Screening
Clinical:
1. Evidence-Based Cervical Cancer
Screening
2. HbA1c Control (<7)
Appropriate Resource Use Measures (will be used to establish a baseline) :
1. Inpatient Utilization—Acute Care Discharges
2. Inpatient Utilization—Bed Days
3. Outpatient Surgeries Utilization—% Done in ASC
4. Emergency Department Visits
5. Inpatient Readmissions within 30 Days
6. Generic Prescribing
1. Blood Pressure Control in Patients
Measures to be collected for
with Diabetes
Testing and Analysis
2. Optimal Diabetes Care
a. HbA1c < 8
b. Blood Pressure <140/90
c. LDL <100
3. Adolescent Immunizations (Tdap,
meningococcal)
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