(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 203
Table 2: Five Measure Domains for Quality Performance Standard
Domain Category Table 1 Measures (Total)
1. Patient/Caregiver Experience 1-7 (7 measures)
2. Care Coordination 8-23 (16 measures)
3. Patient Safety 24-25 (2 measures)
4. Preventive Health 26-34 (9 measures )
5. At-Risk Population/Frail Elderly
Health
Diabetes
Heart Failure
Coronary Artery Disease
Hypertension
Chronic Obstructive
Pulmonary Disorder
Frail Elderly
35-65 (31 measures)
(2) Methodology for Calculating a Performance Score for each Measure within a Domain
We propose that an ACO will receive a performance score on each measure included in
Table 1. For the first year of the Shared Savings Program, these scores would be for
informational purposes, since we propose to set the quality performance standard at the reporting
level. We propose setting benchmarks for each measure using Medicare FFS claims data, MA
quality performance rates, or, where appropriate, the corresponding percent performance rates
that an ACO will be required to demonstrate. For each measure, we propose to set a
performance benchmark and a minimum attainment level as defined in Table 3. The benchmarks
would be established using the most currently available data source and most recent available
year of benchmark data prior to the start of the Shared Savings Program annual agreement
periods. We would determine Medicare FFS rates by pulling a data sample and modeling the
measures. For MA rates, we would check the distribution from annual MA quality performance
data and set the benchmark accordingly. Furthermore, since MA quality performance rates
utilize both claims and clinical data, we propose to use those rates when they are available.
Benchmark levels for each of the measures included in the quality performance standard