Quality Measures to Assess ACO Quality Performance

$179 / year

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.

Complexity

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.

Date Created

2016-01-13

Last Modified

2020-01-23

Version

1

Update Frequency

Biennial

Temporal Coverage

2016-2020

Spatial Coverage

United States

Source

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

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

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, Medicare ACO Quality Performance, 34 Quality Measures to Assess Healthcare ACO, ACO 34 Measures to Assess Quality Performance

NameDescriptionTypeConstraints
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 Measure NumberDomainMeasure DescriptionICD10 CodeICD10 DescriptionHCPCS CodeHCPCS DescriptionNational Quality Forum NumberNotesMeasure StewardMethod Of Data Submission
ACO-1Patient/Caregiver ExperienceConsumer Assessment of Healthcare Providers and Systems (CAHPS): Getting Timely care, Appointments,and InformationZ71.2Person consulting for explanation of examination or test findingsG0495Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes5.0Agency for Healthcare Research and QualitySurvey
ACO-2Patient/Caregiver ExperienceConsumer Assessment of Healthcare Providers and Systems (CAHPS): How Well Your Providers CommunicateZ00.0Encounter for general adult medical examinationG9483Remote in-home visit for the evaluation and management of a new patient for use only in the Medicare-approved Comprehensive Care for Joint Replacement model, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology.5.0Agency for Healthcare Research and QualitySurvey
ACO-3Patient/Caregiver ExperienceConsumer Assessment of Healthcare Providers and Systems (CAHPS): Patients’ Rating of ProviderZ51Encounter for other aftercare and medical careS0281Medical home program, comprehensive care coordination and planning, maintenance of plan5.0Agency for Healthcare Research and QualitySurvey
ACO-4Patient/Caregiver ExperienceConsumer Assessment of Healthcare Providers and Systems (CAHPS): Access to SpecialistsZ71.2Person consulting for explanation of examination or test findingsG0008, G0027, G0101, G0108, G0117, G0118, G0123, G0124, G0128, G0129, G0130, G0141, G0151, G0166, G0168, G0175, G0176, G0177, G0179, G0180, G0186, G0202, G0204, G0206, G0219, G0235, G0237, G0238, G0239, G0248, G0249, G0250, G0252, G0255, G0259, G0260, G0268, G0269, G0270, G0271, G0276, G0277, G0278, G0279, G0281, G0282, G0283, G0288, G0289, G0293, G0294, G0295, G0296, G0297, G0298, G0302, G0303, G0304, G0305, G0306, G0307, G0328, G0329, G0333, G0339, G0340, G0341, G0342, G0343, G0364, G0365, G0372, G0378, G0379, G0380, G0381, G0382, G0383, G0384, G0390, G0398, G0399, G0400, G0402, G0403, G0404, G0405, G0409, G0412, G0416, G0420, G0421, G0422, G0423, G0424, G0428, G0429, G0432, G0433, G0435, G0438, G0439, G0442, G0448, G0451, G0452, G0453, G0454, G0455, G0458, G0460, G0461, G0463, G0466, G0471, G0475, G0476, G0477, G0491, G0498, G0500, G0501, G0502, G0659, G0908, G0913, G0914, G0915, G0916, G0917, G0918, G6001, G6016, G6017, G6030, G9157, G9481, G9490, G9678Procedures/Professional ServicesCenters for Medicare and Medicaid Services/Agency for Healthcare Research and QualitySurvey
ACO-5Patient/Caregiver ExperienceConsumer Assessment of Healthcare Providers and Systems (CAHPS): Health Promotion and EducationZ76.1Encounter for health supervision and care of foundlingG0495, G0496Skilled services of a registered nurse (rn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutes, Skilled services of a licensed practical nurse (lpn), in the training and/or education of a patient or family member, in the home health or hospice setting, each 15 minutesCenters for Medicare and Medicaid Services/Agency for Healthcare Research and QualitySurvey
ACO-6Patient/Caregiver ExperienceConsumer Assessment of Healthcare Providers and Systems (CAHPS): Shared Decision MakingZ71.9Counseling, unspecifiedG9296Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy (e.g., nsaids, analgesics, weight loss, exercise, injections) prior to the procedureCenters for Medicare and Medicaid Services/Agency for Healthcare Research and QualitySurvey
ACO-7Patient/Caregiver ExperienceConsumer Assessment of Healthcare Providers and Systems (CAHPS): Health Status/Functional statusZ00, Z01, Z02, Z03, Z04, Z05, Z06, Z07, Z08, Z09, Z10, Z11, Z12, Z13, Z14, Z15, Z16, Z17, Z18, Z19, Z20, Z21, Z22, Z23, Z24, Z25, Z26, Z27, Z28, Z29, Z30, Z31, Z32, Z33, Z34, Z35, Z36, Z37, Z38, Z39, Z40, Z41, Z42, Z43, Z44, Z45, Z46, Z47, Z48, Z49, Z50, Z51, Z52, Z53, Z55, Z65, Z66, Z67, Z68, Z69, Z70, Z71, Z72, Z73, Z74, Z75, Z76, Z77, Z78, Z79, Z80, Z81, Z82, Z83, Z84, Z85, Z86, Z87, Z88, Z89, Z90, Z91, Z92, Z93, Z94, Z95, Z96, Z97, Z98, Z99Factors influencing health status and contact with health servicesG0507Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care teamCenters for Medicare and Medicaid Services/Agency for Healthcare Research and QualitySurvey
ACO-8Care Coordination/Patient SafetyRisk Standardized, All Condition ReadmissionT80, T81, T82, T83, T84, T85, T86, T87, T88Complications of surgical and medical care, not elsewhere classified (T80-T88)G9309, G9310No unplanned hospital readmission within 30 days of principal procedure, Unplanned hospital readmission within 30 days of principal procedure1789.0AdaptedCenters for Medicare and Medicaid ServicesClaims
ACO-9Care Coordination/Patient SafetyAmbulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older AdultsJ44, J44.0, J44.1, J44.9Other chronic obstructive pulmonary disease, Chronic obstructive pulmon disease w acute lower resp infct, Chronic obstructive pulmonary disease w (acute) exacerbation, Chronic obstructive pulmonary disease, unspecifiedG9681This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary275.0Agency for Healthcare Research and QualityClaims
ACO-10Care Coordination/Patient SafetyAmbulatory Sensitive Conditions Admissions: Heart Failure150, I50.9Heart failure, Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary277.0Agency for Healthcare Research and QualityClaims