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Release Notes:
Data Element
Version 2013B

Data Element Name: Initial Patient Population Size – Medicare Only
Collected For: HBIPS, PC, Transmission, Patient Population Data File , Used in transmission of the Hospital Initial Patient Population Data file.

Refer to the Hospital Initial Patient Population Data XML File Layout in the Transmission section of this manual.
Definition:Indicates the number of episode of care (EOC) records identified for a hospital with Medicare listed as a payment source prior to the application of data integrity filters, measure exclusions, and/or sampling methodology for the specified time period.

The data element is based on the hospital's initial identification of Medicare EOC records for a measure set, stratum, or sub-population. Initial Patient Population Size – Medicare Only includes all patients that are billed under Medicare or Title 18. Medicare can be listed as a primary, secondary, teritary or lower on the list of payment sources for the patient. In addition, patients who are participating as a member of a Medicare HMO/Medicare Advantage are included in the Medicare counts, e.g., Medicare Blue, Humana Gold, Secure Horizons, AARP, Coventry Advantra, etc. This initial data pull utilizes administrative data such as ICD-9-CM diagnosis and procedure codes, admission date, and birthdate.

For the discharge measures (eg. HBIPS-1, 4, PC-01), refer to the Initial Patient Population discussion in the Measure Information section of this manual for more information.

For the HBIPS event measures (HBIPS-2 and 3), the Initial Patient Population Size – Medicare Only is equal to those EOC records in the census data identified as being Medicare EOC records. The HBIPS census data are calculated by (Psychiatric Inpatient Days-Medicare Only - Total Leave Days-Medicare Only). Initial Patient Population Size – Medicare Only is not derived from those cases that pass through the Initial Patient Population algorithm.

If the hospital’s data has been sampled, this field contains the population from which the sample was originally drawn, NOT the sample size.

Suggested Data Collection Question:Not Applicable
Non-stratified Measure Sets:

One Initial Patient Population Size – Medicare Only per hospital’s measure set (e.g., AMI, HF, PN, and STK).

Stratified Measure Sets:

One Initial Patient Population Size – Medicare Only per measure set stratum or sub-population the hospital is participating in:
* The PC measure set has three occurrences, one for the mother sub-population and two for the newborn sub-populations.
* The HBIPS measure set has four occurrences, one for each age stratum.

Refer to the appropriate version of the Specifications Manual for National Quality Inpatient Measures for the number of occurrences for the CAC, VTE, and SCIP measure sets.
Allowable Values:

0 through 999,999

Notes for Abstraction: Initial Patient Population Size-Medicare Only must contain the actual number of patients in the population even if the hospital has five or fewer discharges (both Medicare and non-Medicare combined) in a quarter and has decided to not submit patient level data.
Suggested Data Sources:

Not Applicable

Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None

Initial Patient Population Size – Medicare Only
Specifications Manual for Joint Commission National Quality Measures (v2013B)
Discharges 07-01-13 (3Q13) through 12-31-13 (4Q13)