CMS-1345-F

324

Table 1 Measures for Use in Establishing Quality Performance Standards that ACOs Must Meet for Shared Savings
Domain Measure Title NQF Measure #/ Measure Steward NQF #5, AHRQ NQF #5 AHRQ NQF #5 AHRQ NQF #5 AHRQ NQF #5 AHRQ NQF #5 AHRQ NQF #6 AHRQ NQF #TBD CMS NQF #275 AHRQ NQF #277 AHRQ CMS Method of Data Submission Survey Survey Survey Survey Survey Survey Survey Claims Claims Pay for Performance Phase In R = Reporting P=Performance
Performance Year 1 Year 2 Year 3

AIM: Better Care for Individuals 1. 2. 3. 4. 5. 6. 7. 8. 9. Patient/Caregiver Experience Patient/Caregiver Experience Patient/Caregiver Experience Patient/Caregiver Experience Patient/Caregiver Experience Patient/Caregiver Experience Patient/Caregiver Experience Care Coordination/ Patient Safety Care Coordination/ Patient Safety Care Coordination/ Patient Safety Care Coordination/ Patient Safety Care Coordination/ Patient Safety CAHPS: Getting Timely Care, Appointments, and Information CAHPS: How Well Your Doctors Communicate CAHPS: Patients' Rating of Doctor CAHPS: Access to Specialists CAHPS: Health Promotion and Education CAHPS: Shared Decision Making CAHPS: Health Status/Functional Status Risk-Standardized, All Condition Readmission* Ambulatory Sensitive Conditions Admissions: Chronic Obstructive Pulmonary Disease (AHRQ Prevention Quality Indicator (PQI) #5) Ambulatory Sensitive Conditions Admissions: Congestive Heart Failure (AHRQ Prevention Quality Indicator (PQI) #8 ) Percent of PCPs who Successfully Qualify for an EHR Incentive Program Payment Medication Reconciliation: Reconciliation After Discharge from an Inpatient Facility R R R R R R R R R P P P P P P R R P P P P P P P R P P

10.

Claims

11.

12.

13.

Care Coordination/ Falls: Screening for Fall Risk Patient Safety AIM: Better Health for Populations 14. Preventive Health Influenza Immunization

NQF #97 AMAPCPI/NCQA NQF #101 NCQA NQF #41 AMA-PCPI

EHR Incentive Program Reporting GPRO Web Interface GPRO Web Interface GPRO Web Interface

CMS-1345-F
Domain Measure Title

325
NQF Measure #/ Measure Steward NQF #43 NCQA NQF #421 CMS NQF #28 AMA-PCPI NQF #418 CMS NQF #34 NCQA NQF #31 NCQA CMS NQF #0729 MN Community Measurement NQF #0729 MN Community Measurement NQF #0729 MN Community Measurement NQF #0729 MN Community Measurement NQF #0729 MN Community Measurement NQF #59 NCQA NQF #18 NCQA Method of Data Submission GPRO Web Interface GPRO Web Interface GPRO Web Interface GPRO Web Interface GPRO Web Interface GPRO Web Interface GPRO Web Interface GPRO Web Interface Pay for Performance Phase In R = Reporting P=Performance
Performance Year 1 Year 2 Year 3

15. 16. 17. 18. 19. 20. 21. 22.

Preventive Health Preventive Health Preventive Health Preventive Health Preventive Health Preventive Health Preventive Health At Risk Population Diabetes

Pneumococcal Vaccination Adult Weight Screening and Follow-up Tobacco Use Assessment and Tobacco Cessation Intervention Depression Screening Colorectal Cancer Screening Mammography Screening Proportion of Adults 18+ who had their Blood Pressure Measured within the preceding 2 years Diabetes Composite (All or Nothing Scoring): Hemoglobin A1c Control (<8 percent)

R R R R R R R R

P P P P R R R P

P P P P P P P P

23.

At Risk Population Diabetes

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

GPRO Web Interface

24.

At Risk Population Diabetes

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

GPRO Web Interface

25.

At Risk Population Diabetes

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

GPRO Web Interface

26.

At Risk Population Diabetes

Diabetes Composite (All or Nothing Scoring): Aspirin Use

GPRO Web Interface

27. 28.

At Risk Population Diabetes At Risk Population Hypertension

Diabetes Mellitus: Hemoglobin A1c Poor Control (>9 percent) Hypertension (HTN): Blood Pressure Control

GPRO Web Interface GPRO Web Interface

R R

P P

P P

CMS-1345-F
Domain Measure Title

326
NQF Measure #/ Measure Steward NQF #75 NCQA NQF #68 NCQA Method of Data Submission GPRO Web Interface GPRO Web Interface Pay for Performance Phase In R = Reporting P=Performance
Performance Year 1 Year 2 Year 3

29.

30.

31.

NQF #83 GPRO Web R R P AMA-PCPI Interface 32. NQF #74 GPRO Web R R P CMS Interface (composite) / AMA-PCPI (individual component) 33. At Risk Population Coronary Artery Disease (CAD) Composite: All or Nothing NQF # 66 GPRO Web R R P Coronary Artery Disease Scoring: CMS Interface Angiotensin-Converting Enzyme (ACE) Inhibitor or (composite) / Angiotensin Receptor Blocker (ARB) Therapy for Patients AMA-PCPI with CAD and Diabetes and/or Left Ventricular Systolic (individual Dysfunction (LVSD) component) *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.

At Risk Population Ischemic Vascular Disease At Risk Population Ischemic Vascular Disease At Risk Population Heart Failure At Risk Population Coronary Artery Disease

Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL Control <100 mg/dl Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Heart Failure: Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Coronary Artery Disease (CAD) Composite: All or Nothing Scoring: Drug Therapy for Lowering LDL-Cholesterol

CMS-1345-F

327

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

Performance Year 1 0 33 33 Performance Year 2 25 8 33 Performance Year 3 32 1 33

Pay for Performance Pay for Reporting Total

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