ACO Quality Measures Simplified by Jim Bloedau of Information Advantage Group

Today, the Administration released its final Accountable Care Organization (ACO) regulation, a bit ahead of schedule.  Some initial observations:

At 696 pages, the final rule is more than 50% longer than the 429-page proposed rule released March 31.  From what I can see, much of this increased page volume is from the inclusion of the comments received about the original proposed rules and quality measures and CMS’ response to them and the reasoning about the modifications made to the rules - not from increased complexity or addtional requirements.

As anticipated, the original proposed 65 quality measures have been whittled down to 33 (see page 324).  It is “… a measurement set that includes patient experience, outcomes, and evidence-based processes…” and includes those measures “currently in use in order to encourage participation and reduce reporting burden” with the intent to keep the focus on “… the three-part aim of better care, better health, and lower costs.”  

“This measure set will be the starting point for ACO measurement, as we (CMS) 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.” ”We do not intend to develop specific clinical guidelines for ACOs. Rather, we intend to adopt existing clinical guidelines as appropriate for ACOs in our measure specifications.”

WHAT”S NEW With the Quality Measures: There will be a phasing in of the performance assessment that will be used to determine shared savings for a provider.  Reporting and then use of the results of the quality measures for shared savings.

Complete and accurate reporting on all quality measures (33 measures) for all calendar years will be used to determine shared savings eligibility for an ACO's first performance year. The pay for performance phase-in of measures begins in the second performance year and matures in the third year.

Stay tuned.