CMS Proposes New Quality Measure Changes for Medicare ACO Program

by | Published on Nov 24, 2014 | Insurance Verification and Authorizations

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The Affordable Care Act (ACA) necessitates the Centers for Medicare and Medicaid Services (CMS) to launch a shared savings program to facilitate coordination among healthcare providers thereby improving the quality of care for Medicare fee-for-service beneficiaries.

Accountable Care Organizations (ACO) that participate in the Medicare Shared Savings Program (MSSP) will face a new set of quality measures in the year 2015 (under the proposed Medicare Part B payment rules of the CMS). CMS focuses on increasing the total number of quality measures thereby laying higher emphasis on outcomes.

A total of 12 new measures will be added and 8 current metrics will be eliminated, increasing the set of quality measures from 33 to 37. The new measures relate to four main domains — care coordination/patient safety, patient/caregiver experience, preventive health, and at-risk populations. It is important for ACOs (approximately 350 healthcare organizations scheduled to expand in January) to meet the quality performance measures in order to receive bonuses in the program.

The new MSSP metrics focus on quality measurement programs right from process to outcomes. The proposed rule recommends the inclusion of the following new measures –

  • Consumer assessment of healthcare providers and systems (CAHPS) stewardship of patient resources – This measure aims to find out whether the ACO care team has discussed the prescription medicine costs with the patient.
  • Accurate documentation of current medications in the medical record – It replaces the existing medication reconciliation measure at every office visit, which looks only at whether this was done following a hospital discharge. The new measure integrates with the physician reporting quality system and electronic health records (EHR) incentive program. Healthcare organizations are required to display the percentage of office visits at which medications were reconciled.
  • Skilled Nursing Facility (SNF) 30-day all cause re-admission measure – This proposal estimates the risk-standardized rate of all-cause, unplanned, readmissions for patients who have been admitted to a SNF within 30 days of discharge from prior patient admission to a hospital, critical access hospital or psychiatric hospital.
  • All – cause unplanned readmissions for patients suffering from conditions like heart failure, diabetes mellitus and other multiple chronic diseases.
  • Depression remission at 12 months after diagnosis – Depression is a serious health disorder that can reduce patient adherence to treatment for chronic conditions.
  • Measures for Coronary Artery Disease (CAD) symptom management, CAD Antiplatelet Therapy and CAD Beta Blocker Therapy
  • Diabetes measurement for foot exam and eye exam – these help prevent diabetes-related foot amputations and blindness.
  • Percentage of primary-care physicians who successfully meet meaningful use requirements – It measures the total percentage of primary-care physicians qualified for the EHR incentive payments.

In addition, CMS proposes the deletion of 8 existing measures that have not kept up with the best clinical practices and are redundant with other quality measures. These include –

  • Ischemic vascular disease – Use of aspirin or another antithrombotic
  • Ischemic vascular disease – Complete lipid profile and LDL control (<100 mg/dl)
  • Diabetes composite measure – Hemoglobin A1c control (<8 percent)
  • Diabetes composite – Tobacco non-use
  • Medication reconciliation after discharge from an inpatient facility
  • Diabetes composite – Low density lipoprotein (<100)
  • Diabetes composite – Blood pressure (<140/90)
  • Coronary artery disease (CAD) composite – Drug therapy for lowering LDL cholesterol

It is expected that Accountable Care Organizations (ACOs) will have to start implementing the new quality measures for the year 2015 and report the data to CMS in the year 2016 provided the new proposal is finalized in its current form. As part of the 3 year MSSPs contract, healthcare providers need to make accurate reporting for the first year and demonstrate a specific level of performance for availing the full bonuses.

As part of the new measure, CMS plans to reward quality improvement and will provide up to 2 bonus points in each of its 4 domains of performance specifically for improvement. The bonus points will increase the scores used to calculate how much each ACO receives from shared savings.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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