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.