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Table 1 Measures for Use in Establishing Quality Performance Standards that ACOs Must Meet for Shared Savings

 

Domain

Measure Title

NQF Measure

Method of

Pay for Performance Phase In

#/ Measure

Data

R = Reporting

P=Performance

Steward

Submission

Performance Year 1

Year 2

Year 3

AIM: Better Care for Individuals

 

1.

Patient/Caregiver

CAHPS: Getting Timely Care, Appointments, and Information

NQF #5,

Survey

R

P

P

Experience

AHRQ

2.

Patient/Caregiver

CAHPS: How Well Your Doctors Communicate

NQF #5

Survey

R

P

P

Experience

AHRQ

3.

Patient/Caregiver

CAHPS: Patients' Rating of Doctor

NQF #5

Survey

R

P

P

Experience

AHRQ

4.

Patient/Caregiver

CAHPS: Access to Specialists

NQF #5

Survey

R

P

P

Experience

AHRQ

5.

Patient/Caregiver

CAHPS: Health Promotion and Education

NQF #5

Survey

R

P

P

Experience

AHRQ

6.

Patient/Caregiver

CAHPS: Shared Decision Making

NQF #5

Survey

R

P

P

Experience

AHRQ

7.

Patient/Caregiver

CAHPS: Health Status/Functional Status

NQF #6

Survey

R

R

R

Experience

AHRQ

8.

Care Coordination/

Risk-Standardized, All Condition Readmission*

NQF #TBD

Claims

R

R

P

Patient Safety

CMS

9.

Care Coordination/

Ambulatory Sensitive Conditions Admissions:

NQF #275

Claims

R

P

P

Patient Safety

Chronic Obstructive Pulmonary Disease (AHRQ Prevention Quality Indicator (PQI) #5)

AHRQ

 

10. Care Coordination/

Ambulatory Sensitive Conditions Admissions:

NQF #277

Claims

R

P

P

Patient Safety

Congestive Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 )

AHRQ

 

11. Care Coordination/

Percent of PCPs who Successfully Qualify for an EHR Incentive Program Payment

CMS

EHR Incentive

R

P

P

Patient Safety

Program

 

Reporting

 

12. Care Coordination/

Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility

NQF #97

GPRO Web

R

P

P

Patient Safety

AMA-

Interface

 

PCPI/NCQA

 

13. Care Coordination/

Falls: Screening for Fall Risk

NQF #101

GPRO Web

R

P

P

Patient Safety

NCQA

Interface

AIM: Better Health for Populations

       

14.

Preventive Health

Influenza Immunization

NQF #41

GPRO Web

R

P

P

AMA-PCPI

Interface

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Domain

Measure Title

NQF Measure

Method of

Pay for Performance Phase In

#/ Measure

Data

R = Reporting

P=Performance

Steward

Submission

Performance Year 1

Year 2

Year 3

15.

Preventive Health

Pneumococcal Vaccination

NQF #43

GPRO Web

R

P

P

NCQA

Interface

16.

Preventive Health

Adult Weight Screening and Follow-up

NQF #421

GPRO Web

R

P

P

CMS

Interface

17.

Preventive Health

Tobacco Use Assessment and Tobacco Cessation Intervention

NQF #28

GPRO Web

R

P

P

AMA-PCPI

Interface

18.

Preventive Health

Depression Screening

NQF #418

GPRO Web

R

P

P

CMS

Interface

19.

Preventive Health

Colorectal Cancer Screening

NQF #34

GPRO Web

R

R

P

NCQA

Interface

20.

Preventive Health

Mammography Screening

NQF #31

GPRO Web

R

R

P

NCQA

Interface

21.

Preventive Health

Proportion of Adults 18+ who had their Blood Pressure Measured within the preceding 2 years

CMS

GPRO Web

R

R

P

Interface

22.

At Risk Population - Diabetes

Diabetes Composite (All or Nothing Scoring):

NQF #0729

GPRO Web

R

P

P

Hemoglobin A1c Control (<8 percent)

MN

Interface

 

Community

Measurement

23.

At Risk Population - Diabetes

Diabetes Composite (All or Nothing Scoring): Low Density Lipoprotein (<100)

NQF #0729

GPRO Web

R

P

P

MN

Interface

   

Community

Measurement

24.

At Risk Population - Diabetes

Diabetes Composite (All or Nothing Scoring): Blood Pressure <140/90

NQF #0729

GPRO Web

R

P

P

MN

Interface

   

Community

Measurement

25.

At Risk Population - Diabetes

Diabetes Composite (All or Nothing Scoring): Tobacco Non Use

NQF #0729

GPRO Web

R

P

P

MN

Interface

   

Community

Measurement

26.

At Risk Population - Diabetes

Diabetes Composite (All or Nothing Scoring): Aspirin Use

NQF #0729

GPRO Web

R

P

P

MN

Interface

 

Community

Measurement

27.

At Risk Population - Diabetes

Diabetes Mellitus: Hemoglobin A1c Poor Control (>9 percent)

NQF #59

GPRO Web

R

P

P

NCQA

Interface

28.

At Risk Population - Hypertension

Hypertension (HTN): Blood Pressure Control

NQF #18

GPRO Web

R

P

P

NCQA

Interface

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Domain

Measure Title

NQF Measure

Method of

Pay for Performance Phase In

#/ Measure

Data

R = Reporting

P=Performance

Steward

Submission

Performance Year 1

Year 2

Year 3

29.

At Risk Population – Ischemic Vascular Disease

Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL Control <100 mg/dl

NQF #75

GPRO Web

R

P

P

NCQA

Interface

30.

At Risk Population – Ischemic Vascular Disease

Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic

NQF #68

GPRO Web

R

P

P

NCQA

Interface

31.

At Risk Population - Heart Failure

Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

NQF #83

GPRO Web

R

R

P

AMA-PCPI

Interface

32.

At Risk Population – Coronary Artery Disease

Coronary Artery Disease (CAD) Composite: All or Nothing Scoring:

NQF #74

GPRO Web

R

R

P

CMS

Interface

 

Drug Therapy for Lowering LDL-Cholesterol

(composite) /

AMA-PCPI

(individual

component)

33.

At Risk Population – Coronary Artery Disease

Coronary Artery Disease (CAD) Composite: All or Nothing Scoring:

NQF # 66 CMS (composite) / AMA-PCPI (individual component)

GPRO Web

R

R

P

Interface

 

Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Patients with CAD and Diabetes and/or Left Ventricular Systolic Dysfunction (LVSD)

*We note that this measure has been under development and that finalization of this measure is contingent upon the availability of measures specifications before the establishment of the Shared Savings Program on January 1, 2012.

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Table 2: ACO Agreement Period Pay for Performance Phase-In Summary

 

Performance Year 1

Performance Year 2

Performance Year 3

Pay for Performance

0

25

32

Pay for Reporting

33

8

1

Total

33

33

33

Final Decision: In summary, in response to comments, we have modified this final rule

by reducing the measure set to 33 measures total, or 23 scored measures when accounting for the

patient experience survey modules scored as 1 measure and the all or nothing diabetes and CAD

measures scored as 1 measure each. We believe judiciously removing certain redundant,

operationally complex, or burdensome measures would still provide a high standard of quality

for participating ACOs while providing greater alignment with other CMS and HHS quality

improvement initiatives. This measure set will be the starting point for ACO measurement, as

we plan to modify measures in future reporting cycles to reflect changes in practice and quality

of care improvement and continue aligning with other quality programs.

For the patient/caregiver experience measures, we believe requiring a standardized,

patient experience of care survey that is based on CAHPS will better allow comparisons of

ACOs over time and benchmarking for future years of the program. Additionally, it will help

ensure the patient survey is measuring patient experience for the ACO as a whole rather than for

one specific practice, since there is currently no survey instrument in existence, that we are

aware of, that measures patient experience of care in an ACO specifically. We will also fund the

administration of an annual CAHPS patient experience of care survey for ACOs participating in

the Shared Savings Program in 2012 and 2013. Starting in 2014, ACOs participating in the

Shared Savings Program must select a survey vendor (from a list of CMS-certified vendors) and

will pay that vendor to administer the survey and report results using standardized procedures