(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 212
quality measures and domains outlined in Table 1. We would also use the benchmarks for
performance described in Table 3, established using claims data from FFS Medicare or the
Medicare Advantage program. The minimum quality threshold would be performance at or
above the 50 th percentile (on the performance standards described in Table 3) for each domain:
patient/caregiver experience; care coordination; patient safety; preventive health; and at-risk
population/frail elderly. If an ACO meets these thresholds, it would be eligible for the full 50
percent of shared savings attributable to quality for those participating in the one-sided model,
and the full 60 percent for those participating in the two-sided model. If an ACO failed to meet
this threshold, it would not be eligible for shared savings. We expect that the quality threshold
will increase over time in future rulemaking, under the requirement to improve the quality of
care furnished by the ACO under section 1899(b)(3)(C) of the Act. We solicit comment on this
approach and the appropriate threshold level, and on the pros and cons of the minimum threshold
approach.
(2) Considerations in Establishing a Quality Threshold
The quality threshold option has advantages and disadvantages compared with the
performance standard option. Under the performance standard option, an ACO could receive
rewards for higher quality based on outcomes in one or two domains (for example,
patient/caregiver experience and preventive care), while having very low quality in others (for
example, patient safety). This is true for individual measures (for example, healthcare-acquired
infections) as well. Setting a minimum threshold ensures that all ACOs meet basic standards on
all quality measures, with a special emphasis on patient safety. An ACO's quality outcomes may
vary from year to year due to factors outside of its control, meaning that performance-based
standards could reward ACOs due to random variability. A threshold established at a basic level