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Medicare Spending Per Beneficiary (MSPB) Clinician MeasureClinician Group (TIN) Field Test ReportSample TIN, Maine1Last four digits of your Taxpayer Identification Number (TIN): XXXXMeasurement Period: January 1, 2017 – December 31, 2017Your TIN’s MSPB Clinician Field Test Report Measure Score:MSPB ClinicianMeasureYour TIN’s scoreNational MedianPercentile Rank 16,000 18,69695The MSPB clinician measure score above, and the information contained in this reportare for field testing ONLY. The information in this report does not affect any scoring orpayment adjustments in the Merit-based Incentive Payment System (MIPS). This reporthas been provided for the October 2018 field testing as part of ongoing measure maintenanceand re-evaluation to gather stakeholder feedback.The information contained in this report is believed to be accurate at the time of production. Theinformation may be subject to change at CMS’s discretion, including but not limited to,circumstances in which an error is discovered.State designation is obtained from the CMS Certification Number (CCN) of the inpatient facility whereyour MSPB episodes are initiated. If your TIN practices across multiple states, you are assigned the statein which the plurality of your attributed episodes were initiated. The state-level values do not impact yourTIN’s MSPB clinician measure calculation and are included only to provide meaningful comparisons.1Page 1 of 14

1 RESULTSYour TIN’s MSPB Clinician Measure ScoreThis section details your TIN’s performance on the re-evaluated Medicare Spending PerBeneficiary (MSPB) Clinician measure for field testing only. The MSPB clinician measureassesses your TIN’s performance for MSPB clinician episodes (hereafter referred to as“episodes”) ending between January 1, 2017 and December 31, 2017, inclusive. Only cliniciangroups with at least 35 episodes have received a confidential Field Test Report. After reviewingyour report, please provide your feedback via the 2018 MACRA Field Testing Feedback Survey.For more information on the field testing MSPB clinician measure, please see Section 2.Table 1 displays your TIN MSPB clinician measure score during the measurement period, aswell as your TIN’s percentile rank nationally. A lower measure score indicates that your episodecosts are lower than or similar to the expected for the care provided for the particular patientsand episodes included in the calculation, and a higher measure score indicates the opposite.The percentile rank indicates the percentage of TINs that received the same or higher MSPBclinician measure scores than your TIN. Table 1, titled “MSPB Clinician Measure,” followsimmediately.Table 1: MSPB Clinician MeasureMSPB ClinicianMeasureYour TIN’s scoreNational MedianPercentile Rank 16,000 18,69695Detailed MSPB Clinician Measure StatisticsTables 2-4 below provide detailed breakdowns of your TIN’s episode cost to help youunderstand the factors driving your TIN’s score. Table 2 shows how your episode cost by claimtype compares to the state and national average, Table 3 breaks down your TIN’s episode costby each Major Diagnostic Category (MDC), and Table 4 shows how different categories ofservice (e.g., acute inpatient services or post-acute services) contribute to your episode cost.Table 2 shows your TIN’s episode cost within each claim type for three time periods (3 daysbefore the admission, during the admission, and 30 days after discharge) compared to the stateand national averages. The first column presents your TIN’s average episode cost, and thesecond column provides this as a percentage of total cost of the average episode. The final twocolumns provide the percentage of total cost by claim type for the average TIN in your state andnationally. Table 2, titled “MSPB Clinician Cost Breakdown by Claim Type,” follows immediately.Page 2 of 14

Table 2: MSPB Clinician Cost Breakdown by Claim Type†Time Relative to IndexAdmissionClaim TypeTIN’s Costper EpisodeTINPercentageof Cost†State*Percentageof Cost†NationalPercentageof Cost†Total Pre-Index 160.1%0.1%Carrier 160.1%0.1%Total During-Index 10,91269.0%60.1%Home Health 00.0%0.0%DuringAgencyInpatientDuring 8,84556.0%49.9%OutpatientDuring 00.0%0.0%Skilled Nursing 00.0%0.0%DuringFacilityDurable Medical 00.0%0.1%DuringEquipmentCarrierDuring 2,06713.0%10.1%30 Days Post Discharge Total Post-Index 4,88030.9%39.8%Home Health 3992.5%3.2%30 Days Post DischargeAgencyInpatient30 Days Post Discharge 1,87711.9%12.1%Outpatient30 Days Post Discharge 3982.5%3.4%Skilled Nursing 1,61810.2%16.8%30 Days Post DischargeFacilityDurable Medical 30.0%0.3%30 Days Post DischargeEquipmentCarrier30 Days Post Discharge 5853.7%4.0%† Percentages reported in this table may not add up to 100% due to rounding.* Your TIN is assigned the state in which the plurality of the attributed episodes were initiated.3 Days Prior3 Days PriorDuringPage 3 of 12.4%3.2%15.0%0.3%4.3%

Table 3 compares your TIN’s episode cost by MDC to the average expected cost calculated by the risk adjustment model. The firstcolumn provides your average cost per episode, and the second column, your expected cost, as estimated by the risk adjustmentmodel. The subsequent columns provide the same information at the state and national levels so you can compare the average riskof your patients (as expressed by expected cost) to the state and national average. A higher average expected cost for your TINcompared to the national average indicates that your patients are higher risk than the national average patient. Table 3, titled,“MSPB Clinician Cost Breakdown by MDC,” follows immediately.Table 3: MSPB Clinician Cost Breakdown by MDCNo DataNo dataMDCMDC Description000102Pre-MDC**Nervous SystemEyeEar, Nose, Mouth, andThroatRespiratory SystemCirculatory SystemDigestive SystemHepatobiliary System andPancreasMusculoskeletal Systemand Connective TissueSkin, Subcutaneous Tissue,and BreastEndocrine, Nutritional, andMetabolic SystemKidney and Urinary TractMale Reproductive SystemFemale ReproductiveSystemPregnancy, Childbirth, andPuerperiumNewborn and OtherNeonates (Perinatal Period)03040506070809101112131415Your TINAverageAverageExpectedEpisode CostEpisode CostState*AverageEpisode CostAverageExpectedEpisode de Cost-------- 103,803 20,836 10,898 97,033 20,291 10,695 97,516 20,503 10,380 91,014 20,274 10,221---- 10,605 10,250 10,302 10,162 12,253 20,309 10,456 14,367 21,715 13,288 15,331 20,249 15,588 15,179 20,500 15,317 14,869 20,243 14,971 14,896 20,539 14,975 16,661 17,212 16,283 16,296 15,957 16,173---- 24,121 23,591 24,047 23,688 12,121 14,010 13,690 13,601 13,639 13,658---- 14,461 14,307 14,130 14,162 8,150-- 11,840-- 15,866 13,505 15,388 12,981 15,467 13,109 15,427 12,977---- 14,724 14,488 14,744 14,759---- 8,652 8,797 9,018 8,958------------Page 4 of 14

No DataMDC16171819202122No dataMDC DescriptionBlood and Blood FormingOrgans and ImmunologicalDisordersMyeloproliferative DDs(Poorly DifferentiatedNeoplasms)Infectious and Parasitic DDsMental Diseases andDisordersAlcohol/Drug Use orInduced Mental DisordersInjuries, Poison, and ToxicEffect of DrugsBurnsYour TINAverageAverageExpectedEpisode CostEpisode CostState*AverageEpisode CostAverageExpectedEpisode de Cost 20,362 23,400 15,979 16,223 15,528 15,905---- 29,073 28,502 28,743 28,563 34,879 36,538 21,105 20,866 20,414 20,563---- 14,304 14,334 13,969 14,079---- 12,709 11,444 12,037 11,871 20,474 23,456 15,717 15,623 15,163 15,477---- 21,103 21,729 28,857 28,983Factors Influencing Health-- 16,992 16,596 16,322 16,414Status24Multiple Significant Trauma-- 38,753 37,934 38,570 37,691Human Immunodeficiency25-- 24,569 24,692 22,519 22,967Virus Infection“Ungroupable” episodesUthat could not be assigned-- 37,837 38,058 37,753 37,681to one of the existing MDCs* Your TIN is assigned the state in which the plurality of the attributed episodes were initiated.** MDC 0: Pre-MDC category includes a number of diagnosis and procedure cases, all related to transplants. Pre-MDC DRGs includeextracorporeal membrane oxygenation (ECMO), organ transplants, bone marrow transplants, and tracheostomy cases.23Page 5 of 14

Table 4 breaks down per episode cost by service category. The first two columns indicate the number of episodes that contain anycosts in the service category as a count and as a percentage of your TIN’s total number of episodes. The third column shows theaverage episode cost for each category of service. The subsequent two columns present the national average for cost per episodeand percentage of episodes with costs in the category. The final column indicates how much higher or lower your average episodecost was than the national average for each service category. Table 4, titled “MSPB Clinician Cost Breakdown by Categories ofService,” follows immediately.Table 4: MSPB Clinician Cost Breakdown by Categories of ServiceNo DataService CategoryALL SERVICESAcute Inpatient ServicesAcute Inpatient Hospital: Index AdmissionAcute Inpatient Hospital: ReadmissionServices Billed by Your TIN During IndexHospitalizationServices Billed by Other TINs During IndexHospitalizationOther Physician or Supplier Part B ServicesBilled During Any HospitalizationPost-Acute CareHome HealthSkilled Nursing FacilityInpatient Rehabilitation or Long-Term CareHospitalEmergency Services Not Included in aHospital AdmissionEmergency Evaluation & ManagementServicesYour TINNationalNo dataNumber ofEpisodeswith Costsin thisCategoryPercentage ofEpisodes withCosts in thisCategoryAverageCost PerEpisodePercentageof Episodeswith Costs inThisCategoryAverageCosts perEpisodePercentageDifferenceBetween TIN’sAverage Cost perEpisode andNational AverageCosts perEpisode45454511100.0%100.0%100.0%24.4% 15,808 13,125 8,933 1,877100.0%100.0%100.0%14.0% 18,599 13,166 9,501 1,433-15.0%-0.3%-6.0%31.0%45100.0% 6090.0% 0--45100.0% 1,449100.0% 1,902-23.8%1124.4% 25720.7% 330-22.1%2015744.4%33.3%15.6% 1,977 379 1,59851.6%32.5%25.4% 4,311 629 2,801-54.1%-39.7%-42.9%------4.0% 881--613.3% 20119.6% 13944.6%24.4% 18616.1% 11857.6%Page 6 of 14

No DataService CategoryProceduresLaboratory, Pathology, and Other TestsImaging ServicesOutpatient Evaluation and ManagementServices, Procedures, and Therapy(excluding emergency department)Physical, Occupational, or Speech andLanguage Pathology TherapyEvaluation and Management ServicesMajor ProceduresAnesthesiaAmbulatory/Minor ProceduresAncillary ServicesLaboratory, Pathology, and Other TestsImaging ServicesDurable Medical Equipment and SuppliesAll Other ServicesAmbulance ServicesChemotherapy and Other Part B-CoveredDrugsDialysisAll Other Services Not Otherwise ClassifiedYour TINNationalNo dataNumber ofEpisodeswith Costsin thisCategoryPercentage ofEpisodes withCosts in thisCategoryAverageCost PerEpisodePercentageof Episodeswith Costs inThisCategoryAverageCosts perEpisodePercentageDifferenceBetween TIN’sAverage Cost perEpisode andNational AverageCosts perEpisode1542.2%11.1%8.9% 10 2 36.5%5.2%9.7% 15 1 5-33.3%100.0%-40.0%1533.3% 18429.8% 239-23.0%36.7% 86.8% %6.7%6.7%64.4%6.7% 37 52 4 83 50 24 16 10 271 7015.4%2.4%2.4%10.5%70.7%48.7%35.2%21.6%77.2%9.8% 37 81 4 85 203 60 79 64 541 %-18.6%24.4% 109.9% 114-91.2%-29-73.3%- 1913.8%73.5% 85 256--25.4%Page 7 of 14

National Distribution of MSPB Clinician Measure ScoresFigure 1, which follows immediately, displays a histogram of the national distribution of MSPBclinician measure scores across all TINs.Figure 1: National Distribution of MSPB Clinician Measure ScoresPage 8 of 14

2 ABOUT THE MSPB CLINICIAN MEASURE CLINICIAN GROUP (TIN)REPORTOverview of this reportThe MSPB clinician field testing score was calculated with episodes that ended betweenJanuary 1, 2017 and December 31, 2017, inclusive. Only clinician groups with at least 35episodes have received a confidential field test report.This section provides an overview of field testing and the MSPB clinician measure, a descriptionof the supplementary data file that accompanies this report, and links to additional resources.What is MSPB Clinician?The re-evaluated MSPB clinician measure assesses the cost to Medicare of services providedto a beneficiary during an episode. The episode window comprises the period immediately priorto, during, and following the beneficiary’s hospital admission (also known as the “indexadmission” for the episode). Medicare Part A and Part B claims concurrent to the episodewindow are considered for inclusion, with exceptions for unrelated services, as determinedthrough clinical review. The list of services deemed clinically unrelated can be found in the DraftMSPB Clinician Measure Codes List file on the MACRA Feedback Page along with the draftmeasure methodology.What is field testing?Field testing is a voluntary opportunity for clinicians and other stakeholders to provide feedbackon the draft measure specifications for the cost measures, the field test report format, and thesupplemental documentation. We will be field testing the 13 measures in their current stage ofdevelopment and re-evaluation to seek clinician and other stakeholder feedback by: Posting confidential clinician field test reports for group practices and solo practitionerswho meet the minimum number of cases2 for each measure on the CMS EnterprisePortal. Posting mock reports, draft measure specifications, and supplemental documentation onthe MACRA Feedback page.3We are collecting stakeholder feedback from October 3, 2018 to October 31, 2018. Pleaseprovide your feedback on any aspect of field testing via the 2018 MACRA Field TestingFeedback Survey.Supplemental data fileIn addition to this report, your TIN has received an episode-level data file in Comma SeparatedValue (CSV) format. This data file provides detailed information on every episode used toA case can be an episode or a beneficiary depending on the measure.CMS, “Episode-based cost measures,” MACRA Feedback e 9 of 14

calculate your measure score. Your TIN can use the information contained in this file to performmore detailed analysis of how individual episodes are contributing to your measure score.Additional ResourcesFor more information on the MSPB clinician measure, please visit the MACRA Feedback Page.4If you have further questions, please call 1-866-288-8292 (TTY 1-877-715-6222), Mondaythrough Friday, 8:00 AM-8:00 PM ET or email [email protected], “Episode-based cost measures,” MACRA Feedback rams/MACRA-MIPS-and-APMs/MACRA-Feedback.html4Page 10 of 14

Appendix A – MSPB Clinician Measure Score Calculation BreakdownTable 5 provides more information on your TIN’s performance. This table allows you to followthe calculation of your TIN’s measure score, and to compare your score to state and nationalaverages. Table 5, titled “Statistics of Your TIN’s MSPB Clinician Performance,” followsimmediately.Table 5: Statistics of Your TIN's MSPB Clinician PerformanceRow123StatisticYour TINState*Number of Eligible Admissions45.00254,017.00Average Standardized Episode Cost 15,808.00 18,902.67Average Risk-Adjusted Expected Episode 18,375.36 18,691.94Cost4Average Episode Cost Ratio0.861.015Standardized National Average Cost per 18,598.54 18,598.54Episode6MSPB Clinician Measure Score 16,000.00 18,831.90* Your TIN is assigned the state in which the plurality of the attributed episodes were initiated.National6,369,424.00 18,598.54 18,598.541.00 18,598.54 18,599.85Your TIN’s MSPB clinician measure score is calculated as follows:1. Calculate the standardized observed cost of an MSPB clinician episode by summing allpayment-standardized Medicare claims payments during the episode window, excludinga defined list of services.o Please see PAYMENT STANDARDIZATION in the Appendix B for moreinformation.2. Calculate the risk-adjusted expected cost of that MSPB clinician episode using the riskadjustment model.o Please see RISK ADJUSTMENT in the Appendix B for more information.3. Divide the standardized cost obtained in step (1) by the expected cost obtained in step(2) to obtain the episode cost ratio for each episode.4. Exclude outliers to mitigate the impact of extremely high- or low-cost episodes on thetotal measure score, and average the episode cost ratio obtained in step (3) across all ofyour TIN’s MSPB clinician episodes (the number of episodes in Table 5, row 1).o Your average episode cost ratio can be found in Table 5, row 4.5. Multiply the average episode cost ratio obtained in step (4) by the standardized nationalaverage MSPB clinician episode cost (Table 5, row 5) to obtain your measure score(Table 5, row 6). Due to rounding of the average episode cost ratio, this multiplicationmight not yield the exact value represented in row 6.o We multiply by the national average to convert the average ratio into a figure thatis more meaningful from a cost perspective by having the average cost measurescore represented as a dollar amount rather than a unit-less ratio.Page 11 of 14

Appendix B – GlossaryATTRIBUTIONAttribution is the process of determining which clinician (or clinicians) is responsible for anepisode. In the MSPB clinician measure, there are different methods of attribution depending onwhether the Medicare Severity Diagnosis-Related Group (MS-DRG) is medical or surgical. An episode with a medical MS-DRG is attributed to a:o TIN if that TIN billed at least 30 percent of the evaluation and management (E&M)claims billed during the inpatient stay, and to ao TIN-NPI if the clinician within an attributed TIN billed at least one E&M claim that wasused to determine the episode’s attribution to the TIN.An episode with a surgical MS-DRG is attributed to a:o TIN if that TIN billed the relevant Current Procedural Terminology/HealthcareCommon Procedure Coding System (CPT/HCPCS) code determined to be related tothe surgical MS-DRG, and to ao TIN-NPI if the clinician billed the relevant CPT/HCPCS code determined to be relatedto the surgical MS-DRG.More details on the attribution process can be found in the MSPB clinician measuremethodology documentation on the MACRA Feedback Page.ELIGIBLE CLINICIAN5MIPS eligible clinicians include: Physicians, which includes doctors of medicine, doctors of osteopathy (includingosteopathic practitioners), doctors of dental surgery, doctors of dental medicine, doctorsof podiatric medicine, doctors of optometry, and chiropractors; Physician assistants (PAs); Nurse practitioners (NPs); Clinical nurse specialists; Certified registered nurse anesthetists; and Any clinician group that includes one of the professionals listed above.EPISODE WINDOWThe episode window for MSPB clinician is the period from 3 days prior to the hospital admissionuntil 30 days after discharge.EXPECTED COSTSee RISK ADJUSTMENTPlease note that the definition of eligible clinicians may be subject to change through rulemaking. Formore information on MIPS eligibility, please see About MIPS Participation on the QPP bout5Page 12 of 14

INDEX ADMISSIONThe index admission is the period between the beneficiary’s admission date and discharge dateof their hospital stay, inclusive.PAYMENT STANDARDIZATIONThe MSPB clinician measure is payment standardized to take into account payment factors thatare unrelated to the care provided (such as add-on payments for medical education andgeographic variation in Medicare payment amounts)6. The standardized payment methodologyachieves the following:1. Eliminates adjustments made to national allowed payment amounts to reflect differences inregional labor costs and group expenses (measured by hospital wage indexes andgeographic practice cost indexes).2. Eliminates payments to hospitals for larger program goals, including graduate medicaleducation indirect medical education (IME); serving a disproportionate population of poorand uninsured (i.e., disproportionate share payments (DSH)); and payments associated withincentive payment programs.3. Substitutes a national amount for services paid on the basis of state fee schedules.4. Maintains differences in actual payments resulting from the choice of setting in which aservice is provided, the choice of who provides the service, and the choice of whether toprovide multiple services in the same encounter.RISK ADJUSTMENTRisk adjustment is used to estimate expected episode costs in recognition of the different levelsof care beneficiaries may require due to comorbidities, disability, age, and other risk factors. Aseparate risk adjustment model is estimated for episodes within each MDC. This model includesvariables from the CMS Hierarchical Condition Category Version 22 (CMS-HCC V22) 2016 RiskAdjustment Model7 and other standard risk adjustors to capture beneficiary characteristics whichare identified using Medicare Parts A and B claims that end in the 90-day lookback period fromthe episode start date. Further detail about the MSPB clinician risk adjustment model isprovided below: The MSPB clinician risk adjustment methodology includes 12 age categorical variables.Severity of illness is measured using the MS-DRG of the index hospitalization, anindicator for any prior acute hospital admission, and 79 HCC indicators derived from thebeneficiary’s claims in the 90-day lookback period.For more information, please refer to the “CMS Price (Payment) Standardization - Basics" and “CMSPrice (Payment) Standardization - Detailed Methods” documents posted on rver?c Page&pagename QnetPublic/Page/QnetTier4&cid 12287720573507 CMS uses an HCC risk adjustment model to calculate risk scores. The HCC model ranks diagnoses intocategories that represent conditions with similar cost patterns. Higher categories represent higherpredicted healthcare costs, resulting in higher risk scores. There are over 9,500 ICD-10-CM codes thatmap to one or more of the 79 HCC codes included in the CMS-HCC V22 model.6Page 13 of 14

The model includes status indicator variables for whether the beneficiary qualifies forMedicare through disability or age, End-Stage Renal Disease (ESRD), and whether thebeneficiary is receiving long-term care.In addition, the model accounts for interactions between particular variables. Interactionterms are included because the presence of certain patient characteristics can increaseexpected cost in a greater way than predicted by the indicators alone.Page 14 of 14

** MDC 0: Pre-MDC category includes a number of diagnosis and procedure cases, all related to transplants. Pre-MDC DRGs include extracorporeal membrane oxygenation (ECMO