Issue #3 August 2026

Healthcare Quality & Patient Safety Intelligence

A monthly letter from Jennifer Giusti at Just Performance, LLC

The Pulse

For years, many hospital quality measures reflected only traditional Medicare patients. Starting in October, that changes. CMS is adding Medicare Advantage data to all six Hospital Readmissions Reduction Program measures and to key stroke and joint-replacement outcome measures.

In this issue I will focus on this major change and, believe it or not, connect it to my eye opening trip to Cuba last December.

And as always, you’ll find a brief update from my farm in Georgia at the end.

— Jennifer

🔬 IN FOCUS: 35 million Medicare Advantage Patients Now Count

Have you heard? Are you ready?

In the FY 2026 IPPS final rule, CMS finalized the addition of Medicare Advantage data to the six HRRP readmission measures, alongside Medicare fee-for-service data. The agency also shortened the HRRP applicable period for performance measurement from three years to two, with the changes beginning in the FY 2027 program year.

CMS made parallel changes to the 30-day, risk-standardized mortality measure following acute ischemic stroke hospitalization and the complication measure following elective primary total hip or knee arthroplasty. Both will now include Medicare Advantage patients and switch to a two-year performance period. CMS also updated their risk-adjustment methodology, moving from Hierarchical Condition Categories to ICD-10 codes.

With Medicare Advantage now accounting for roughly half of Medicare enrollment nationally, CMS’s affected measures may draw from a substantially larger and more representative patient cohort. In markets where MA represents about half of a hospital’s Medicare volume, adding MA patients could nearly double the eligible population informing performance.

Publicly reported and payment-linked results will therefore reflect more of the Medicare patients a hospital actually serves — and, with the shorter measurement period, more recent performance. A strategy built only around fee-for-service claims, historic workflows, and post-discharge patterns just isn't going to cut it anymore.

Your action: Quantify Medicare Advantage volume for each affected measure. Compare MA and fee-for-service outcomes, readmissions, and post-acute utilization now — FY 2027 performance data is about to start accumulating.

The changes above raise an important question: as the measured population becomes more complete, will the organization also become more complete in how it understands the conditions that drive outcomes? Claims and quality measures can show where performance varies. They cannot, on their own, explain whether a patient could obtain medication, make a follow-up appointment, arrange transportation, or rely on support at home.

That question connects directly to an experience that has stayed with me since last December...

🔬 IN FOCUS: A Week Observing Family Medicine in Cuba

Cuba has been in the news frequently lately — usually in connection with political and economic turmoil. It shows up in this issue, too, but for a different reason: my week with MEDICC in Cuba last December observing the country’s family-medicine approach and healthcare infrastructure. Cuba’s context is profoundly different from the United States, and it is not a system the US can or should replicate. But its emphasis on knowing patients and families at the neighborhood level raises a useful question for U.S. health systems: Do our measures help us see the conditions that shape recovery, or only the outcomes after those conditions have taken effect?

That question matters as hospitals prepare for MA inclusion in CMS measures. More complete data is an important step. The next step is using it to understand variation in care pathways — including access to primary care, medication, follow-up, transportation, and community-based support — before that variation becomes a readmission, complication, or mortality outcome.

My first article in a five-part LinkedIn series shares observations from Cuba and discusses The Power of Knowing Your Community. I hope you'll give it a read and follow the series.

👀 What I'm Watching

Data exchange, data usability, and measurement validity are three related—but different—leadership responsibilities.

Data usability becomes the interoperability test: The Sequoia Project, HL7 Da Vinci, and FAST are focusing attention on the practical barriers that determine whether exchanged data can be used: identity, consent, endpoint discovery, data quality, usability, and workflow alignment. For dQMs, this is the critical distinction between receiving FHIR data and having trustworthy data that can support valid measurement and improvement. HL7Blog​

Trebuchet takes FHIR standards into production: The Da Vinci Trebuchet pilot community is testing payer-provider and clearinghouse workflows using FHIR implementation guides, including hybrid X12/FHIR prior-authorization exchange. These pilots are worth watching because value-based care increasingly depends on repeatable, scalable data exchange rather than one-off interfaces. HL7News​

CMS’s dQM direction raises the governance question: CMS’s QualTech initiative includes a next-generation digital quality-measure calculator intended to support approximately 70 dQMs converted from existing eCQMs. The near-term question for health systems is whether their data-governance model can validate source data, preserve clinical context, and turn measure results into improvement action. eCQI​

We will dive into more detail next month!

And finally... News from The Farm

It's the "dog days" of summer in Chattahoochee Hills. With a few cows thrown in for good measure.

This time of year there is plenty of sunshine and frequent thunderstorms. The recipe for great fescue in the pastures and a healthy dose of humidity. We've got happy cows and a busy puppy. Maisie is already 7 months old!