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Specifications Manual for Joint Commission National Quality Measures (v2016B1)
Home » Initial Patient Population Size – Medicare Only

Release Notes:
Data Element
Version 2016B1

Data Element Name: Initial Patient Population Size – Medicare Only
Collected For: All Records, Transmission, Patient Population Data File
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-10-CM diagnosis and ICD-10-PCS procedure codes, admission date, and birthdate.

For the discharge measures (eg. HBIPS-1, STK-1, 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.

Note:
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
Format:
Length:6
Type:Numeric
Occurs:
Non-stratified Measure Sets:

One Initial Patient Population Size – Medicare Only per hospital’s measure set (e.g. GLB).

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.
* The STK measure set has two occurrences, one for each sub-population.

Note:
Refer to the appropriate version of the Specifications Manual for National Quality Inpatient Measures for the number of occurrences for the VTE measure set.
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 (v2016B1)
Discharges 01-01-17 (1Q17) through 06-30-17 (2Q17)
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