Quality Measures and Performance Standards
Quality data reporting and collection support quality measurement, an important part of the Shared Savings Program. Before an ACO can share in any savings generated, it must demonstrate that it met the quality performance standard for that year. There are also interactions between ACO quality reporting and other CMS initiatives, particularly the Physician Quality Reporting System (PQRS) and meaningful use. The sections below provide resources related to the program’s 33 quality measures, which span four quality domains: Patient / Caregiver Experience, Care Coordination / Patient Safety, Preventive Health, and At-Risk Population. Of the 33 measures, 7 measures of patient / caregiver experience are collected via the CAHPS survey, 3 are calculated via claims, 1 is calculated from Medicare and Medicaid Electronic Health Record (EHR) Incentive Program data, and 22 are collected via the ACO Group Practice Reporting Option (GPRO) Web Interface.
Narrative Specifications for all 33 Measures
2014 reporting period narrative measure specifications for the 33 quality measures are available and can be accessed in the following file:
ACO GPRO Measures
Visit the GPRO Web Interface page for ACO GPRO measures documents related to the 2014 reporting period, including: narrative measure specifications; supporting documents; measure flows; XML specifications; and training videos, as well as Q&A resources. This web site will be updated periodically before and during the reporting period as these and other resources are made available.
Administrative and Claims Based Measures
In this section, we provide Measure Information Forms (MIFs) that include technical specifications for ACO claims-based and administrative measures for the 2014 reporting period.
- ACO #8 Risk Standardized All Condition Readmission [PDF, 372KB]
- ACO #9 – Prevention Quality Indicator (PQI): Ambulatory Sensitive Conditions Admissions for Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults [PDF, 259KB]
- ACO #10 – Prevention Quality Indicator (PQI): Ambulatory Sensitive Conditions Admissions for Heart Failure (HF) [PDF, 257KB]
- ACO #11 – Percent of Primary Care Physicians Who Successfully Qualify for an EHR Program Incentive Payment [PDF, 298KB]
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey for ACOs participating in Medicare Initiatives will be administered yearly. Visit the ACO CAHPS webpage http://acocahps.cms.gov to access the current survey, to find vendor information, to learn how to become an approved vendor and more.
- Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year [PDF, 237KB] – *Update* This document describes methods for calculating the quality performance benchmarks for Accountable Care Organizations that are participating in the Shared Savings Program and presents the benchmarks for the 33 quality measures for the 2014 quality reporting years. This document also reviews the quality performance thresholds and scoring, as described in the Shared Savings Program regulations. These benchmarks will apply to Shared Savings Program ACOs’ whose second or third performance years, of their initial 3-year agreement period, occur during the 2014 reporting period
Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year [PDF, 276KB]
– *Update* This document describes methods for calculating the quality performance benchmarks for Accountable Care Organizations that are participating in the Shared Savings Program and presents the benchmarks for the 33 quality measures for the 2015 quality reporting year and measure set changes finalized in the 2015 Physician Fee Schedule Rule. This document also reviews the quality performance thresholds and scoring, as described in the Shared Savings Program regulations. These benchmarks will apply to Shared Savings Program ACOs’ whose second or third performance years, of their initial 3-year agreement period, occur during the 2015 reporting period.
Medicare Shared Savings Program Interaction with the Physician Quality Reporting System (PQRS) [PDF, 177KB]
– This document describes the eligibility of ACO Participant TINs and their physicians and practitioners for PQRS incentives and the applicability of the PQRS downward payment adjustment based on GPRO quality measures reporting by ACOs participating in the Shared Savings Program. The document also includes answers to frequently asked questions about the interaction and timing between the Shared Saving Program and the traditional PQRS.
2015 Reporting Year Documentation
Over coming months we will make available resources related to quality measurement for the 2015 reporting period, including measure-specific documentation and resources reflecting adjustments to the ACO quality performance standard finalized with the 2015 Physician Fee Schedule (PFS) Final Rule (November 2014).
- Narrative Specifications – This document provides narrative specifications for the 33 quality measures applicable to the 2015 reporting year.
- ACO GPRO Measures – Visit the GPRO Web Interface page for related resources.
- Administrative and Claims Based Measures – 4 new claims-based measures were finalized with the 2015 PFS, in addition to the existing claims-based measures in the 33 quality measure set.
- MIFs for 2015 [ZIP, 3MB] . This zip file will be updated with additional documentation for all administrative and claims-based measures.
- CAHPS Survey for ACOs – stay tuned for announcements about changes to the CAHPS survey to be effective with the 2015 reporting period.
Prior Reporting Years’ Documentation
- Page last Modified: 03/02/2015 12:23 PM
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