Under a proposed rule change issued by CMS, as a part of the anticipated 2015 Physician Fee Schedule, the number of quality measures used to assess accountable care organizations in the Medicare Shared Savings Program would increase from 33 to 37.
Here are four things to know about the proposed changes with regard to ACOs:
1. The proposed changes would add the following new measures:
• The Stewardship of Patient Resources which asks the patient whether the care team talked with them about the costs of prescription medication, would become a scored measure.
• A 30-day all-cause skilled nursing facility measure, which monitors the rate of readmission within 30 days of being discharged from a hospital, would be come a scored measure.
• A depression readmission at twelve months measure to the Preventative Health domain would be added as a scored measure.
• The diabetes measure for foot exam and eye exam would be added to the Clinical Care for at Risk Population-Diabetes domain.
• The coronary artery disease symptom management measure, the coronary artery disease antiplatelet therapy measure and the coronary artery disease beta blocker therapy — prior myocardial infarction or left ventricular systolic dysfunction measure would be added to the Clinical Care for At Risk Population-Coronary Artery Disease domain and included in the CAD Composite Measure.
• The Documentation of Current Medication in the Medical Record measure would replace the current ACO #12 Medication Reconciliation measure.
2. CMS plans to retire eight measures that "have not kept up with clinical best practice, are redundant with other measures that make up the quality reporting standard, or that could be replaced by similar measures that are appropriate for ACO quality reporting," the proposal states. CMS plans to remove:
• ACO #12, Medication reconciliation after discharge from an inpatient facility
• ACO #22, Diabetes composite measure: Hemoglobin A 1 c Control(<8 percent)
• ACO #23, Diabetes composite: Low density lipoprotein (<100)
• ACO #24, Diabetes composite: blood pressure (<140/90)
• ACO #25, Diabetes composite: Tobacco non-use
• ACO #29, Ischemic vascular disease: Complete Lipid profile and LDL control (<100mg/dl)
• ACO #30, Ischemic vascular disease: Use of aspirin or another antithrombotic.
• ACO #32, Coronary artery disease composite: Drug therapy for lowering LDL cholesterol
3. CMS proposes that the new total of 37 measures be used for establishing the quality performance standards that ACOs must meet to achieve shared savings.
4. Under the proposal, the measures added would be calculated by CMS using administrative claims data or data from a patient survey. The number of measures that ACOs are required to report through the CMS website interface would actually decrease by one as a result of the proposed changes.
CMS included the change in the PFS because the proposed rule also contains updates to the group practice reporting option, — the web interface many ACOs use to report quality data.
CMS will accept comments on the proposed rules until Sept. 2, specifically requesting comments on care coordination, health outcomes, nursing home quality, prevention, and utilization. CMS is expected to release final regulations around Nov. 1.
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