External Related Documents with Glossaries:
CMS 2019 Blueprint - see Glossary and Acronyms page 355
Gap in Care:
A “Gap In Care” is defined as a discrepancy between recommended best practices and the services that are actually provided and documented.
| TERM | ACRONYM | DEFINITION |
|---|---|---|
Payload | All data needed to perform analysis. | |
Lookback period | The historical time frame during which measure compliance can be determined. Varies by measure and based on the longest clinically meaningful period. | |
| Measurement Period | The time period for which the measure applies. (CMS its typically the calendar year) (Synonym with performance period ?) Note: CMS measures call it Performance Period for EP measures but calls it Reporting Period for Hospital side | |
| Performance Period | The time period for which the measure applies. (CMS its typically the calendar year) (Synonym with measurement period ?) Note: CMS measures call it Performance Period for EP measures but calls it Reporting Period for Hospital side | |
| Retrospective | Analysis that looks backwards in historical data and looks for gaps as defined in a measure. | |
| Prospective | Predictive, likely to happen at a future date; concerned with or applying to the future. Identifies opportunities to close gaps, “due soon”, “reminders”, calculation based on domain period, proactively show providers when gap will occur. First opportunity to close “date” for prescribed service. Benefit issues/rules need to be taken into account (e.g. dentist visit every 6 months and NOT before 6 month + one day. | |
Authorities | Organizations that define quality measures or metrics and thus the respective gaps.
| |
| Stakeholder | A person, role, or organization with an interest in this use case: payers, providers, care managers | |
| Services | An act the performed to, for or with a patient or group of patients such as a procedure, intervention, medication administration, assessments, education,counseling etc | |
| Risk-Based Contract | A risk contract is, broadly, any contract which results in any party assuming insurance or business risk. In health care, the employer, health plan or provider assumes risk. It is agreeing to cover the expense of increased utilization beyond the projected costs or payment provided | |
| Value-Based Contract | Value-based contracting is a contract with a provider where a portion of the provider’s total potential payment is tied to a provider’s performance on cost-efficiency and quality performance measures. | |
| Attestation | A a declaration that a service or services happened or that metrics were met. (as opposed to electronic data evidence) | |
Attribution List | Enumeration of patients who are attributed to, providers, medical homes or groups. May be at the individual provider level and the organization level. "Medical Home" concept may become more common. Also group + provider level - provider might be member of many groups. NPI and TIN - combo of the two to attribute _ Patient + provider + TIN or NPI algorithm = attribution Is this the same as the Gaps in Care list? Maybe not. Any provider (not necessarily the attributed provider) - can close a gap in care - based on appt only for "within workflow" | |
| Attributed Provider | Provider responsible for the health of the Patient per the contract and will receive the payments and credits based on performance. | |
| Attribution | The action of ascribing a patient or group of patient's to a particular provider or organization. This would be performed by payer and might be performed by a provider or provider group | |
| Supplemental Data Elements (CMS) | Variables used to aggregate data into various subgroups. CMS-required supplemental data are payer, ethnicity, race, and sex. In addition there | |
| Supplemental Data (Gaps flow) | From Notes: Supplemental EHR data - list of gaps that can be pulled from EMR and transmit to a health plan (e.g., mammograms, colon screening data, etc.) - anything that health plan didn't receive for some reason. Is it data that's provided in supplemental report (i.e., list of data agreed upon with health plan that provider will supply) - payer receives monthly Internet Resources:
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| Measure Set | A measure set is a unique grouping of measures, that when viewed together, provide a robust picture of the care within a given domain (e.g., cardiovascular care, pregnancy). | |
| Measure - Composite Performance | A combination of two or more component measures, each of which individually reflects quality of care, into a single performance measure, also called composite measures, with a single score. | |
| Measure - Continuous Variable (CV) | A measure score in which each individual value for the measure can fall anywhere along a continuous scale and can be aggregated using a variety of methods such as the calculation of a mean or median (e.g., mean number of minutes between presentation of chest pain to the time of administration of thrombolytics). | |
| Measure | AHRQ defines a measure as a mechanism to assign a quantity to an attribute to enable comparisons among entities over time. A measure may stand alone or belong to a composite, subset, set, and/or collection of measures. NQF states a healthcare performance measure is a way to calculate whether and how often the healthcare system does what it should. Measures are based on scientific evidence about processes, outcomes, perceptions, or systems that relate to high-quality care. | |
| Measure - Process | A measure that focuses on steps that should be followed to provide good care. There should be a scientific basis for believing that the process, when executed well, will increase the probability of achieving a desired outcome. | |
| Measure - Proportion | A score derived by dividing the number of cases that meet a criterion for quality (i.e., the numerator) by the number of eligible cases within a given time frame (i.e., the denominator) where the numerator cases are a subset of the denominator cases (e.g., percentage of eligible women with a mammogram performed in the last year). | |
| Deferral | A clinical reason that the gap is not being closed (for xx? time) that is not defined in the referenced measure as an exception or exclusion. e.g Flu shot not given b/c patient has URI. Deferrals ARE NOT defined exclusions | |
| Patient Panel | Within a group practice the assignment by who the patient considers their primary provider. There is some reshuffling that occurs by the care manager to handle this. The "how" may be a black box. It would be very valuable to support these change in an automated way. |
1 Comment
Gini McGlothin
Reviewed and think this looks good.