Quality Measures to Assess ACO Quality Performance for 2016

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This dataset shows the 34 Quality Measures for the ACO Quality Performance for 2016; prepared in January 13, 2016 by RTI International for the Pioneer ACO Model: Division of Accountable Care Organization Populations, Seamless Care Models Group and Center for Medicare and Medicaid Innovation, and the Medicare Shared Savings Program: Division of Shared Savings Program, Performance-Based Payment Policy Group, Center for Medicare and Centers for Medicare & Medicaid Services.


On November 2, 2011, the Centers for Medicare & Medicaid Services (CMS) established the Medicare Shared Savings Program (Shared Savings Program), as authorized by the Patient Protection and Affordable Care Act (Affordable Care Act), to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).

Participation in ACOs creates incentives for health care providers to work together voluntarily to coordinate care and improve quality for their patient population. Since the 2011 Shared Savings Program final rule, updates have been made to the Shared Savings Program quality measures, scoring, and quality performance standard have been made in subsequent Shared Savings Program and Physician Fee Schedule rules.

ACOs are required to completely and accurately report quality data that are used to calculate and assess their quality performance. In addition, in order to be eligible to share in any savings generated, an ACO must meet the established quality performance standard that corresponds to its performance year. CMS most recently updated the quality measure set in the 2016 Physician Fee Schedule Final Rule by adding a Statin Therapy for the Prevention and Treatment of Cardiovascular Disease measure in the Preventive Health Domain to address National Quality Strategy and CMS Strategy goals and to align with PQRS and the Million Hearts Initiative. This document presents the 34 quality measures used to assess ACO quality performance for the 2016 quality reporting year ACOs participating in the Shared Savings Program. Enrichments have also been made to include appropriate ICD10 and HCPCS codes for each ACO measure.

**ACO Quality Measures**
CMS will measure quality of care using 34 nationally recognized quality measures in four key domains:
1. Patient/Caregiver Experience (8 measures)
2. Care Coordination/Patient Safety (10 measures)
3. Clinical Care for At-Risk Population
– Diabetes (2 measures scored as 1 composite measure)
– Hypertension (1 measure)
– Ischemic Vascular Disease (1 measure)
– Heart Failure (1 measure)
– Coronary Artery Disease (1 measure)
– Depression2 (1 measure)
4. Preventive Health (9 measures)

The 34 quality measures will be reported through a combination of CMS claims and administrative (EHR Incentive Program) data (8 measures), a CMS-provided web portal (i.e., the Group Practice Reporting Option [GPRO] Web Interface) designed for capturing ACO-reported clinical quality measure data (18 measures), and a patient experience of care survey (8 measures).

Measures are provided at-a-glance in Table 1. For each measure, the table arranges measures by domain and provides (1) the ACO measure number and GPRO Web Interface measure number (if applicable), (2) the title of the measure, (3) the measure’s National Quality Forum (NQF) number (if available), (4) the measure steward, and (5) the method of data submission. Note that the two diabetes measures within the At Risk Population domain are scored as one “all-or-nothing” composite performance rate.

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John Snow Labs; Centers for Medicare and Medicaid Services (CMS) and RTI International;

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Medicare Shared Savings Program, ACO, ACO Healthcare, Accountable Care, Medicare ACO, Healthcare ACO, Shared Savings Program, ACO 34 Measures

Other Titles

What is an ACO?, Assessment of ACO Healthcare Quality Performance for 2016, Medicare ACO Quality Performance for 2016, 34 Quality Measures to Assess Healthcare ACO 2016, ACO 34 Measures to Assess Quality Performance for 2016

ACO_Measure_NumberDescription of the Accountable Care Organization number that is used to assess quality measure.string-
DomainThe description of the domain or criteria to be assessed for quality measure.string-
Measure_DescriptionDetailed description of the domain for quality measurement.string-
ICD10_CodeThe International Classification of Diseases ICD-10 code/codes for a specific ACO measure.string-
ICD10_DescriptionDescription used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care.string-
HCPCS_CodeThe Healthcare Common Procedure Coding System (HCPCS) code/codes for a specific ACO measure.string-
HCPCS_DescriptionDescription of the Level II of the HCPCS standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.string-
National_Quality_Forum_NumberThe number used for endorsement of proposed or existing quality measures for implementation in CMS reporting programs.integerlevel : Ordinal
NotesThe description of special notes applicable for any data included in the dataset.string-
Measure_StewardThe description of the organization responsible or accountable for the approval or implementation of the quality measure.string-
Method_Of_Data_SubmissionThe description of the method to be used in submitting the results of the quality measure performance assessment.string-
ACO - 12Care Coordination/Patient SafetyMedication Reconciliation
ACO - 32At-Risk Population CAD Drug Therapy for Lowering LDL Cholesterol
ACO - 25At-Risk Population DiabetesTobacco Non UseZ72.0Tobacco useG9903Pt scrn tbco id as non user
ACO - 26At-Risk Population DiabetesAspirin UseZ79.82Long term (current) use of aspirinG9277Doc daily aspirin or contra
ACO - 29At-Risk Population IVDPercent of beneficiaries with IVD with complete lipid profile and LDL control < 100mg/dl
ACO - 23At-Risk Population DiabetesLow Density Lipoprotein (LDL) (<100 mg/dL)E78.0, E78.1, E78.00Pure hypercholesterolemia, Pure hyperglyceridemia, Pure hypercholesterolemia, unspecifiedG8039Cad pt w/ldl>100mg/dl
ACO - 24At-Risk Population DiabetesBlood Pressure (BP) < 140/90Z01.30, Z01.31Encounter for exam of blood pressure w/o abnormal findings, Encounter for exam of blood pressure w abnormal findingsG8478Bp not performed/doc
ACO-36Care Coordination/Patient SafetyAll-Cause Unplanned Admissions for Patients with DiabetesE08Diabetes mellitus due to underlying conditionG8779Diabetes screening test not performed, reason not givenCenters for Medicare and Medicaid ServicesClaims
ACO-39 (CARE-3)Care Coordination/Patient SafetyDocumentation of Current Medications in the Medical RecordGZ3ZZZZMedication Management†S9981Medical records copying fee, administrative419Centers for Medicare and Medicaid ServicesGroup Practice Reporting Option (GPRO) Web Interface
ACO-37Care Coordination/Patient SafetyAll-Cause Unplanned Admissions for Patients with Heart FailureI50.9Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiaryCenters for Medicare and Medicaid ServicesClaims