2019 SSP Quality Measurement Methodology and Resources Document

Transcript

1 Medicare Shared Savings Program QUALITY MEASURE MENT METHODOLOGY AND RESOURCES Specifications February 2019 Version 2019 Applicable for Performance Year 2019

2 Revision History AFFECTED AREA VERSION MAJOR REVISION S DESCRIPTION All 2019 Updated performance year references to 2019 -1, participation scenarios 2019 Added and edited text to reflect 2019 Section 1.2, Section 1.3, Table 1 Section 1.4, Section 3.1 Updated list of measures for the 2019 performance year, 2019 - Section 2 Intro, Section 2.1, Table 2 1, Table 2-2, Table 2-3, Table -11. including removal of section on ACO 2-4, -3, Section 4.3, -1, Table 4 Table 4 -5, Table 4-4, Table 4 Table 2-5 Provided list of informational measures 2019 2019 Updated selected benchmarks for 2019 Section 4.1 2019 Added section on CEHRT attestation requirement Section 5.1 i Shared Savings Program | Quality Measurement Methodology Medicare and Resources

3 Table of Contents ... 4 1 Introduction 1.1 Quality Measure Structure and Data Collection Methods Overview ... 4 1.2 Quality Reporting for a Performance Year ... 4 1.3 Quality Standard and ACO Transition from Pay-for -reporting to Pay -for - performance ... 7 1.4 Relationship Between Quality Performance and Financial Performance ... 9 ... 1.5 Quality Measure Resources 9 2 Quality Domains and Measures ... 11 2.1 Patient/Caregiver Experience Measures ... 11 2.2 Care Coordination/Patient Safety Measures ... 13 2.3 Preventive Health Measures ... 13 2.4 At-Risk Population Measures ... 14 Informational Measures ... 14 2.5 15 3 Quality Measure Data Collection and Performance Rate Calculations ... Beneficiary selection for Quality Measurement 15 ... 3.1 3.2 ... 17 Patient/Caregiver Experience Survey Data Survey Administration ... 17 3.2.1 Survey Sample and Survey Procedures 3.2.2 17 ... 3.2.3 Survey Scale and Performance Rate Determinations ... 18 3.3 Claims -Based Data ... 20 3.4 CMS Web Interface Data ... 20 21 3.4.1 Accessing and Reporting Data through the CMS Web Interface ... 3.4.2 CMS Web Interface Measures Samples ... 21 3.4.3 CMS Web Interface Measure Performance Rates ... 22 4 Quality Performance Scoring ... 22 4.1 Quality Measure Benchmarks ... 22 4.1.1 Benchmark Data Sources ... 22 Quality Measure Scoring ... 23 4.2 25 4.3 Quality Measure Domain Scoring ... 25 ... Quality Improvement Reward Scoring 4.3.1 Program | Quality Measurement Methodology and Resources Medicare Shared Savings 2

4 Domain Score ... 27 4.3.2 4.4 Quality Score ... 28 4.5 Quality Measures Validation Audit ... 29 30 ... 4.6 Compliance 5 Alignment with the Quality Payment Program ... 31 31 5.1 ... Certified Electronic Health Record Technology (CEHRT) Use 32 List of Acronyms ... List of Tables Table 1-1. Phase-in of Policies by Applicant Type 8 ... ... Table 1-2. One-sided Models and Two-sided Models 9 Table 1-3. Sources of Measure Documentation by Measure Type and Links for 2019 Documentation ... 10 Table 2-1. Patient/Caregiver Experience Measures (2019) ... 12 Table 2-2-2. Care Coordination/Patient Safety Measures (2019) ... 13 Table 2-3. Preventive Health Measures (2019) ... 13 14 Table 2-4. At -Risk Population Measures (2019) ... 14 Table 2-5. Informational Measures (2019) ... Table 4-1. Points Associated with Meeting or Passing Each Benchmark Level ... 24 Table 4-2. Crosswalk between Improvement Measure Score and Quality Improvement ... 27 Points Table 4-3. Total Points for Each Domain Within the Quality Performance Standard (2019) ... 27 Table 4-4. Example of Domain Scores for an ACO in Performance Year 1 that ... 28 Completely Reported Table 4-5. Example of Domain Scores for an ACO Beyond Performance Year 1... 29 List of Figures 6 ... Figure 1-1. Timeline of Quality Reporting and Performance Assessment Activities Medicare Shared Savings Program | Quality Measurement Methodology and Resources 3

5 1 Introduction Within the Medicare Shared Savings Program (Shared Savings Program), the Centers for Medicare & Medicaid Services (CMS) enters into agreements with Accountable Care Organizations (ACOs). CMS rewards ACOs with shared savings when they are able to lower growth in Medicare Parts A and B fee-for -service (FFS) costs while also meeting performance standards on quality of care. Before an ACO can share in any savings, it must demonstrate that it met the quality performance standard for that year. The quality performance standard determines an ACO’s eligibility to share in savings, if earned, and the extent of an ACO’s liability for sharing losses if owed (for ACOs participating under a two -sided shared savings/losses model). This document reviews the quality performance standard and scoring methodology for ACOs participating in the Shared Savings Program and describes the Shared Savings quality measurement and reporting Program’s . Examples in the sections methodology to follow focus on Performance Y ear 2019. This document is subject to periodic change and will be updated to reflect the policies applicable for each subsequent reporting year. CTURE AND DATA 1.1 QUALITY MEASURE STRU COLLECTION METHODS OVERVIEW CMS focuses ACO quality performance and improvement activity on four key domains to serve as the basis for assessing, benchmarking, rewarding, and 1-1) (refer to Figure improving ACO quality performance. weigh To determine an ACO’s quality performance score, CMS ts each of the four , to encourage ACOs to focus on all domains , at 25 percent measure domains equally The number of measures within the four key domains has changed over time to reflect ing toward m ore outcome- based measures, and to changes in clinical practice, mov and programs burden. However, the to reduce align with other quality reporting structure of the measure domains and their equal weighting has remained consistent in determining an ACO’s quality score. 1.2 QUALITY REPORTING FO R A PERFORMANCE YEAR Quality data collection for a performance year occurs after the end of the calendar year, during 2018 , the performance year the “ quality data reporting period.” For example, for for ACO submission of the performance year 2018 data through data collection period between January the CMS Web Interface will occur 22, , 2019. 2019 and March 22 Note that in 2019, some ACOs will participate in one or two 6- month performance years . (or performance period) and others will participate in one 12- month performance year Specifically, the following scenarios may occur: An ACO enters a 12- ▪ month performance year on January 1, 2019 Program | Medicare Shared Savings Quality Measurement Methodology and Resources 4

6 ▪ An ACO extends their agreement by 6 months from January 1, 2019, through 30, 2019 June early renewed An ACO begins an agreement on July 1, 2019 (including ACOs ▪ that extended their agreements by 6 months and their prior agreement, and ACOs that renew for a new agreement period, and ACOs entering the program ). A single quality data reporting period covering all of calendar year 2019 will be used to 59953 through 59955, 83 FR 67959 FR assess quality in all of these scenarios (see 83 67961). through Program | Medicare Shared Savings Quality Measurement Methodology and Resources 5

7 meline of Quality Reporting and Performance Assessment Activities . Ti 1-1 Figure Medicare Shared Savings 6 Quality Measurement Methodology and Resources Program |

8 1.3 QUALITY STANDARD AND ACO TRANSITION FROM -PERFORMANCE PAY -FOR -FOR -REPORTING TO PAY criteria that an ACO must meet in order The quality performance standard is the specific to be eligible to share in any savings earned, and also determines the magnitude of losses for which an ACO may be liable (under a two-sided shared savings/losses model). CMS designates the quality performance standard for ACOs based on performance year rather than financial track . The quality performance standard for ACOs in the first year of their first agreement period differs from the quality performance standard applied in later performance years, as indicated in the following outline: - In the f ▪ -for irst year of the first agreement period, all measures are scored as pay reporting (P4R): ACOs must completely and accurately report all quality data used to calculate and assess their quality performance. econd or third year of the first agreement period and all years of subsequent In the s ▪ -for -performance (P4P) according , measures are scored as pay agreement periods in schedule that is specific to measures and the ACO’s performance year to a phase- in the Shared Savings Program: ACOs must continue to completely and accurately report all quality data used to – calculate and assess their quality performance. – CMS designates a performance benchmark for each P4P measure and establishes a point scale for the measure. An ACO’s quality performance for a measure is evaluated using the appropriate point scale, and these measure- specific scores are used to calculate a quality score for the ACO. ACOs must meet minimum attainment (defined as the 30th percentile benchmark – for P4P measures and complete reporting for P4R measures) on at least one be eligible to share in any savings generated. measure in each domain to Whether an ACO’s performance on quality measures is scored as P4R or P4P for a particular year depends on the ACO’s performance year and agreement start date. the second performance year s begin to phase in to P4P in ACO first agreement of their period and continue to phase into P4P during the third performance year of an ACO’s first agreement p eriod. ACOs in a second or subsequent agreement period continue As noted in the 2019 Shared under P4P for the length of the ir agreement period. 1-1 Table Savings Program Final Rule below , we defined the following and in participation options, as we believed it was appropriate to consider an ACO’s experience with the Program for the purposes of applying policies that phase-in over the course of an ACO’s agreement, such as the phase-in of measures from P4R to P4P: Program | Medicare Shared Savings Quality Measurement Methodology and Resources 7

9 Table 1-1 . Phase -in of Policies by Applicant Type APPLICANT TYPE AGREEMENT PERIOD FOR POLICIES THAT PHASE -IN OVER TIME ( PHASE IN OF PAY -FOR -PERFORMANCE) legal entity New ACO agreement period. These ACOs should refer to “PY1” of First the phase -in schedule. -entering the ACOs re Either: The next consecutive agreement period if the ACO’s program (1) prior agreement expired, or if new legal entity is identified entering ACO because more than 50% of its as a re- ACO participants recently participated in an ACO whose agreement period expired. These ACOs should refer to in schedule. “PY3” of the phase- first performance year of the same agreement The (2) period in which the ACO was participating at the time of termination, if the ACO’s prior agreement was terminated, or if new legal entity is identified as a re- entering ACO because more than 50% of its ACO participants recently participated in an ACO whose terminated agreement period was terminated. ACOs that in their first agreement period should refer to “PY1” of the phase- in schedul e. ACOs that terminated in a subsequent agreement period should refer to “PY3” of in schedule. the phase- If new legal entity is identified as re- (3) entering ACO because more than 50% of its ACO participants recently participated in an ACO that is currently in the Shared Savings Program, t he new ACO would be considered to be entering into the same agreement period in which this other ACO is currently participating, beginning with the first performance year of that agreement period. If the ACO is in their first agreement period, ACOs should refer to “PY1” of the phase- in a in schedule. If the ACO is subsequent agreement period, A COs should refer to “PY3” of the phase -in sche dule. consecutive agreement period. These ACOs should refer Next ACOs renewing their -in schedule. to “PY3” of the phase agreement There is also a phase-in process for measures added to the Shared Savings Program. in of For more information on the phase- measures from P4R to P4P, please refer to Section 4.1. Medicare Shared Savings Program | Quality Measurement Methodology and Resources 8

10 RELATIONSHIP BETWEEN QUALITY PERFO RMANCE 1.4 AND FINANCIAL PERFORMANCE An ACO’s final sharing rate, which is based on quality performance, is used to determine the ACO’s eligibility for shared savings and liability for shared losses for ACOs under two-sided track or level. and Two- -sided Models . One 1-2 sided Models Table MODEL ONE -SIDED MODEL TWO -SIDED AGREEMENT START DATE Agreement start date Track 1 Track 2, Track 3, Track 1+ January 1 , 2019 and prior Model Level A and Level B Agreement start date July 1, of the Level C, Level D, and Level E of the BASIC track 2019 and beyond ; BASIC track ENHANCED track The final sharing rate is equal to the product of the ACO’s final quality score and the maximum sharing rate specific to the financial model under which the ACO participates . , if An ACO under a two-sided shared savings/losses model will also share losses applicable. In general, ACOs with relatively h igher quality scores will be eligible to share in a larger amount of savings . ACOs in Track 2 and the ENHANCED track (Track 3) with relatively higher quality scores will be liable for a smaller amount of losses compared to ACOs with lower quality scores , because the loss sharing rate is determined based on quality performance. BASIC track However, ACOs under the Track 1+ Model and the ’s two - sided models have a fixed loss sharing rate of 30% that is not adjusted for the final quality score. For information on the calculation and amount of savings an ACO may receive or losses for which an ACO may be liable, refer to the Shared Savings and Losses and Assignment Methodology Specifications . An ACO that fails to meet the quality performance standard (complete reporting for ACOs in their first performance year of their first agreement period, complete reporting ng minimum attainment on at least one measure in each domain for all other and meeti will be ineligible for a shared savings payment for the for the performance year ACO s) performance year. For ACOs participating under a two-sided shared associated will result in del, failure to meet the quality performance standard savings/losses mo application of the highest sharing rate for losses for the performance year. 1.5 URCES QUALITY MEASURE RESO year, measure documentation is made available through the For each performance , Shared Savings Program website and the Quality Payment Program Resource Library Program | Medicare Shared Savings Quality Measurement Methodology and Resources 9

11 and documentation for prior reporting years remains accessible through the CMS website in an archived format . As summarized in Table 1-3 below , CMS maintains a variety of publicly available sources of technical documentation on quality measures, including documentation for reporting year 201 9. As shown in Table 1-3 below, CMS maintains a variety of publicly available sources of technical documentation on quality measures, including documentation for reporting year 2019. Table 1-3 . Sources of Measure Documentation by Measure Type and Links for 201 9 Documentation 9 201 DESCRIPTION DOCUMENT MEASURE TYPE NAME N* DOCUMENTATIO Web Interface Detailed information to Quality Visit the -reported ACO Measures & measures Payment Program support data collection and supporting Resource Library reporting through the CMS for documents Web Interface. Supporting CMS Web Interface documents provide measure reporting instructions for documentation each measure. Measure flows contain performance rate calculation algorithms. CMS Web ACO -reported Detailed information Forthcoming Interface measures regarding the documentation documentation that will be guides needed to substantiate data elements for each measure in the event of an audit Measure Shared Savings Quality Payment Detailed descriptive Information information on each Program website Program data and , Forms (MIFs) measure. claims -based under “ 2019 Measure measures Information Forms ” CAHPS for The CAHPS for ACOs Patient/ care - CAHPS for ACOs ACOs giver experience questions Survey includes Survey website measures CAHPS , from the CG- , and supplemental items -specific items. program Benchmarks 2019 Quality Refer to Basis for determining an All measures Measure Benchmarks ACO ’s performance on a measure used for quality measure scoring under P4P. ance year. The links provided, or related content, may change. for each perform *Resources are updated Program | Medicare Shared Savings Quality Measurement Methodology and Resources 10

12 2 Quality Domains and Measures For Performance Year 2019, CMS will measure quality of care using 23 nationally recognized quality measures that span four key domains: 1. Patient/Caregiver Experience (10 measures) 2. Care Coordination/Patient Safety ( 4 measures) 3. Preventive Health ( 6 measures) 4. At-Risk Population ( 3 measures) (1 measure) Mental Health – – Diabetes ( 1 measures ) – Hypertension (1 measure) These measures are calculated via several means: • CAHPS for ACOs Survey, which includes CAHPS Clinicians & Group (CG - CAHPS) core measures, supplemental items, and program -specific items Medicare claims data and Medicare beneficiaries’ demographic data • Data reported by ACOs through the CMS Web Interface using patient medical • record data from within and outside the ACO collection data More information regarding for these measures is available in Section 3. PATIENT /CAREGIVER EXPERIENC E MEASURES 2.1 The measures in the Patient/Caregiver Experience domain are collected via the CAHPS Consumer Assessment of Healthcare Providers and Systems ( ) for ACOs Survey. The CAHPS for ACOs Survey is based on the Clinician and Group ( CG )- 1 CAHPS Survey and includes additional content relevant to patient /caregiver the CG -CAHPS core experience with care delivered by an ACO. The survey includes survey, CG -CAHPS supplemental items, program -specific items (measure sources and Table 2-1 below). The measures are referred to as summary survey are indicated in measures (SSM) because the survey includes multiple questions for most of the measures. For 2019 , CMS will continue to provide a single version of the CAHPS for ACOs Survey , which was streamlined in 2018 to 58 items and implemented for performance year 10 -45 (Courteous and Helpful Office Staff) and The survey includes ACO SSMs. 2018. 1 -CAHPS Survey is maintained by the Agency for Healthcare Research and Quality (AHRQ) and The CG used by CMS for measuring quality performance of ACOs on patient and caregiver experience of care. Medicare Shared Savings Program | Quality Measurement Methodology and Resources 11

13 -46 (Care Coordination) were previously provided for informational purposes, but ACO starting in performance year 2019 they will be scored as part of the Shared Savings . The SSMs 2019 survey are outlined in Program quality measure set included in the below . Table 2-1 2-1 . Patient/Caregiver Experience Measures ( 9) Table 201 SUMMARY SURVEY METHOD OF ACO SOURCE USED TO DAT A MEASURE CALCULATE MEASURE # SUBMISSION QUALITY SCORE? -1 Getting Timely Care, Survey ACO core items Yes Appointments, and Information ACO How Well Your Providers Survey core items Yes -2 Communicate ACO -3 Patients’ Rating of Provider Survey core item Yes supplemental ACO Access to Specialists Survey -4 Yes item Yes supplemental Survey Health Promotion and ACO -5 Education items -6 Survey ACO supplemental Shared Decision Making Yes items ACO -7 * Survey core and Yes Health Status & Functional supplemental Status items supplemental ACO -34 Stewardship of Patient Yes Survey item Resources s -45 Courteous & Helpful Office Yes Survey ACO core items Staff ACO Care Coordination Yes items -46 core Survey *ACO -7 is pay -for -reporting in all years of an ACO’s agreement. ACOs will receive 2 points on this measure in quality scoring (see Section 4) if the ACO completely reports the CAHPS measures. includes questions to collect information on English proficiency, The survey also -reported race and ethnicity categories. disabilit CMS has translated the y, and self and Russian, Spanish, Mandarin, Portuguese, Korean, survey into Cantonese, Vietnamese. Medicare Shared Savings Program | Quality Measurement Methodology and Resources 12

14 2.2 CARE COORDINATION/PA TIENT SAFETY MEASURE S ty domain are listed in in the Care Coordination/Patient Safe scored The measures Table 2-2 below. Measures in this domain are collected via Medicare claims data, Quality Payment Program data, and the CMS Web Interface. Table 2-2 . Care Coordination/Patient Safety Measures ( 201 9) ACO MEASURE # MEASURE TITLE METHOD OF DAT A SUBMISSION ACO Risk -Standardized, All Condition Readmission CMS -8 calculates from c laims ACO -38 All -Cause Unplanned Admissions for Patients with CMS Multiple Chronic Conditions calculates from c laims ACO -43 Ambulatory Sensitive Condition Acute Composite CMS (AHRQ Prevention Quality Indicator (PQI) #91) calculates from c laims Falls: CMS Web -2) Screening for Future Fall Risk ACO -13 (CARE Interface Note: Text in parentheses is the equivalent CMS Web Interface measure identifier. ASURES PREVENTIVE HEALTH ME 2.3 The measures in the Preventive Health domain are listed in Ta ble 2-3 below. scored Measures in this domain are collected via the CMS Web Interface. Table 2-3 2019) . Preventive Health Measures ( ACO MEASURE # METHOD OF DAT A MEASURE TITLE SUBMISSION ACO -14 (PREV -7) Preventive Care and Screening: Influenza CMS Web Interface Immunization ACO -10) Preventive Care and Screening: Tobacco Use: CMS Web Interface -17 (PREV Screening and Cessation Intervention ACO -18 (PREV- 12) Preventive Care and Screening: Screening for Web Interface CMS -up Plan Clinical Depression and Follow ACO -19 (PREV -6) Colorectal Cancer Screening CMS Web Interface ACO Breast Cancer Screening -5) -20 (PREV Web Interface CMS Program | Medicare Shared Savings Quality Measurement Methodology and Resources 13

15 ACO MEASURE # MEASURE TITLE METHOD OF DAT A SUBMISSION -42 (PREV -13) Statin Therapy for the Prevention and ACO CMS Web Interface Treatment of Cardiovascular Disease Note: Text in parentheses is the equivalent CMS Web Interface measure identifier. 2.4 AT -RISK POPULATION MEAS URES The measures scored in the At -Risk Population domain are listed in Table 2-4 below. Measures in this domain are collected via the CMS Web Interface. Table 2-4 . At-Risk Population Measures ( 201 9) ACO MEASURE # MEASURE TITLE METHOD OF DAT A SUBMISSION ACO -40 (MH -1) Depression Remission at Twelve Months CMS Web Interface -2) -27 (DM Web Interface CMS Diabetes: Hemoglobin A1c Poor Control ACO CMS -2) Controlling High Blood Pressure -28 (HTN Web Interface ACO Note: Text in parentheses is the equivalent CMS Web Interface measure identifier. 2.5 INFORMATIONAL MEASUR ES Some measures are provided to ACOs in a Quarterly Quality Report for infor mational purposes only and are not part of the official Shared Savings Program quality measure set. These measures are listed in Table 2-5. . Informational Measures (2019) Table 2-5 MEASURE TITLE ACO MEASURE # METHOD OF DAT A SUBMISSION ACO -35 Skilled Nursing Facility 30 —Day All -Cause CMS calculates from claims Readmission Measure ACO -36 All -Cause Unplanned Admissions for Patients CMS calculates from with Diabetes claims CMS calculates from All -Cause Unplanned Admissions for Patients ACO -37 claims with Heart Failure -44 Use of Imaging Studies for Low Back Pain CMS calculates from ACO claims Program | Quality Measurement Methodology and Resources Medicare Shared Savings 14

16 3 Quality Measure Data Collection and Performance Rate Calculations This section describes the approach for determining the patient sample and the procedures for collecting/reporting data, as well as the approach for calculating performance rates. Using the quality measure data collected using Medicare claims data ( claims -based measures), or submitted by ACOs (CMS Web Interface measures) CMS endors (CAHPS for ACOs Survey measures), calculates performance and survey v rates for each measure for each ACO based on the measure specifications ( refer to Section 1. 5). Performance rates are used to determine the points an ACO earned on each measure Program’s according to the Shared Savings quality benchmarks, which are described in results for all quality measures as part of Section 4.1. ACOs will receive performance their annual quality performance reports. ACOs will also receive a CAHPS for ACOs detailed report with additional data related to their performance on the patient/caregiver experience of care measures. FOR QUALITY BENEFICIA RY SELECTION 3.1 MEASUREMENT A subset of an ACO’s assigned beneficiaries will be used in quality measurement for the Shared Savings Program —including , CMS Web Interface the CAHPS for ACOs Survey —i f they meet the criteria outlined below, which -based measures measures, and claims month performance year (or performance period) and ACOs in a apply to ACOs in a 6- 12- month performance year . As previously noted, a single quality data reporting period covering all of calendar year 2019 will be used to assess quality in all of these scenarios . Criteria 1. Beneficiary is assigned to an ACO. ACOs For ▪ under preliminary prospective assignment with retrospective assignment in the 2 ACOs and ACOs selecting retrospective assignment (i.e., Track 1 and Track or ENHANCED track): BASIC track – of calendar year preliminary prospectively assigned beneficiaries Second quarter will be used for the CAHPS for ACOs Survey sample . However, the sample for nary the CAHPS for ACOs be determined based on the initial prelimi will Survey prospective assignment list for the 6-month performance year beginning on July 1, 2019. of calendar year preliminary prospectively assigned beneficiaries Third quarter – will be used for CMS Web Interface sampling. Program | Quality Measurement Methodology and Resources Medicare Shared Savings 15

17 Fourth quarter of calendar year prelim inary prospectively assigned beneficiaries – will be used for claims -based measure calculations. ▪ For ACOs with prospective assignment (i.e., Track 3, and Track 1+ Model ACOs and ACOs selecting prospective assignment in the BASIC track or ENHANCED track): – Pro spectively assigned beneficiaries maintaining eligibil ity as of the second of the calendar year will be use d for the CAHPS for ACOs Survey quarter However, the sample for the CAHPS for ACOs Survey will be sample. determined based on the initial prospective assignment list for the 6- month performance year beginning on July 1, 2019. – maintaining Prospectively assigned beneficiaries eligibil ity as of the third quarter of the calendar year will be used for CMS Web Interface sampling. – Prospectively assigned beneficiaries maintaining eligibil ity as of the fourth quarter -based measure calculations. will be used for claims of the calendar year 2. The beneficiary is eligible for use in quality measurement. Criteria rvey For the CAHPS for ACOs Su ▪ : CMS will include in the survey sample assigned beneficiaries (as identified in – Step 1 above) who are 18 years or older, excluding those who: primary care service visits within the ACO during the • Received fewer than two performance year (beneficiaries receiving care only from hospitalists are excluded); • Entered hospice during the performance year; • Died during the performance year; Center Hemodialysis CAHPS Survey; • Were sampled for the In- ere i resided nstitutionalized ( in a group home or institution such as a W • 2 hospice or nursing home). F or the CMS Web Interface measures : ▪ will include in the measure samples assigned beneficiaries (as identified in – CMS 1 above), excluding those who: Step 3 D • o not meet measure-specific age criteria; 2 Quality Assurance Guidelines Refer to , version 6 (June 2018). CAHPS® Survey for ACOs Survey 3 Patient age is determined during the sampling process, and patients must meet age criteria for the s of the measurement period. measure on the first and last day Program | Quality Measurement Methodology and Resources 16 Medicare Shared Savings

18 Received fewer than two primary care services within the ACO during the • performance year; • Entered hospice during the performance year; • Died during the performance year; • Do not meet measure-specific eligibility criteria as described in the measure specifications (refer to Section 1.5). iciary is eligible benef determines ▪ For claims -based measures, CMS n assigned if a the criteria for each measure as described in the for the quality measure based on measures documentation (refer to Section 1.5). 3.2 PATIENT/CAREGIVER EX PERIENCE SURVEY DATA SURVEY ADMINISTRATIO 3.2.1 N ACOs are responsible for selecting and paying for CMS -approved vendor s to administer the CAHPS for ACOs Survey to a random sample of FFS beneficiaries assigned to the -approved CAHPS for ACOs Survey for the reporting year. CMS vendors collect ACO data between October and January to CMS. responses and deliver -approved CAHPS for ACOs Survey ACOs must have a contract in place with a CMS vendor for each reporting year. CMS maintains a list of approved CAHPS for ACOs accessible through the Survey vendors, which is site CAHPS for ACOs web . ACOs are required to authorize a CMS -approved v endor using a web-bas ed vendor authorization identifies the ACO’s survey vendor. The window for completion of vendor tool —which authorization closes in September. 3.2.2 SURVEY SAMPLE AND SURVEY PROCEDURES FFS beneficiaries assigned to an ACO who are CMS randomly samples 860 Medicare eligible for the survey sample as described in Section 3.1. Further more , 25 percent of eac h ACO’s sample will be drawn from “high users of care. ” High users of care are beneficiaries with the top 10 percent of primary care claim charge s within the ACO. CMS will deliver the beneficiary sample to each ACO’s selected vendor. High users of care are oversampled to increase the likelihood that survey questions measuring less common experiences garner an adequate number of responses. mode data collection The CAHPS for ACOs Survey is collected using mixed- pre- Sampled beneficiaries are mailed a notification letter, followed by up to procedures. two survey mailings. After several weeks, sampled beneficiaries who do not respond by mail are contacted by telephone and invited to answer the survey via an interview. Beneficiaries may receive up to six telephone calls. Program | Medicare Shared Savings Quality Measurement Methodology and Resources 17

19 3.2.3 SURVEY SCALE AND PERFORMANCE RATE DETERM INATIONS reflect the CAHPS suite of The response scales of the CAHPS for ACOs Survey SSMs surveys maintained by AHRQ. The response scale is the list of response options for one item. An ACO’s performance rates on patient/caregiver experience SSMs are calculated submitted by an ACO’s survey vendor. Each of the scored using survey responses The process of developing the 0-100 scores for each SSM -100 score. SSMs gets a 0 consists of the following steps: Step 1. Assign points for individual question responses . The first step in scoring is to convert survey respondents’ descriptive responses into For example, the numerical values using the response scale for the survey question. question “In the past six months, how often did your provider explain things in a way that was easy to understand?” has the following response scale: ▪ 1 – Never 2 – Sometimes ▪ 3 – Usually ▪ ▪ 4 – Always for “Yes” and zero (0) scales , CMS assigns a value of one ( 1) For Yes/No response for “No .” T he numeric response values of the separate Yes/No and Never/Always response scales indicate the ordinal ranking of responses within each scale. If we were to compare the response values to the two response scales, the equivalent comparison for raw numeric values is “Always = 4” as both are the top response value “Yes = 1” and s are made across for their respective response scales. In scoring, no direct comparison raw response values (that is, we don’t equate “Yes = 1” to “Always = 4” ). After assigning a numeric value to each response, CMS applies sampling weights that compensate for oversampling of high users of care (previously described). Perform case mix adjustment . Step 2. to adjust for differences in Case mix adjustment is a multi-step process and is applied beneficiary characteristics (‘case mix’). These adjustments are based on linear on a particular survey question (the regression models that describe responses ics (“case- dependent variable) as a linear function of respondent characterist mix ,” or independent variables). adjustors Scores are adjusted for the following respondent characteristics: age, education, self - -reported mental health status, Medicaid dual eligibility, low - reported health status, self income subsidy eligibil ity, survey completion in an Asian language, and whether another person helped the respondent complete the survey (“proxy assistance”). Medicare Shared Savings Program | Quality Measurement Methodology and Resources 18

20 All variables are used to adjust scores for all measures, with the exception of the Health Status and Functional Status SSM and the sharing health information question within 4 the Shared Decision- SSM. Making ACO’s An the ACO’s estimated mean mean score after case- mix adjustment represents score after adjustment for differences between the case mix of their assigned ciaries and the case mix of the national average of beneficiaries assigned to all benefi mix adjusted score is the mean that would . In other words, the case- participating ACOs were equal be obtained for a given ACO if the average case mix variables for that ACO to the national average across all participating ACOs . The ACO’s actual mean score will be adjusted upward or downward for a given measure depending on how different the patient population of the ACO is mix. , relative to the national average case Step 3. T ransform scores to 0-100 scale. Finally, weighted, case- mix adjusted numerical responses are converted to a 0-100 performance the poorest the best and 100 scale, where zero represents represents scale using the following approach. performance. Scores are converted to this SSM are First, the weighted, adjusted responses for each question of a given ▪ averaged to produce the overall SSM score on the original survey response scale. ▪ Next, this average score is transformed to the 0-100 scale using the following formula: ▪ Y = 0 -100 score ▪ X = ACO’s CAHPS score on its original scale a ▪ = minimum possible score on the original scale ▪ = maximum possible score on the original scale b For SSMs composed of items with different response scales, the transformation from the original response scale to the 0-100 scale is performed before taking the average across scales. mix adjusted mean for the Table 3-2 below provides an example of how the case- Access to Specialists SSM would be converted from its original scale to the 0-100 scale for three hypothetical ACOs. The Access to Specialists SSM is a single-question SSM, which means there is only one question that contributes to the overall measure. The one question is as follows: “In the last 6 months, how often was it easy to get 4 -rated health, The Health Status and Functional Stat us summary survey measure is not adjusted for self your information within the self- rated mental health, and proxy assistance. The question on s health haring Decision making measure is not adjusted for proxy assistance. Shared Medicare Shared Savings Program | Quality Measurement Methodology and Resources 19

21 appointments with specialists?” The response scale is as follows, with 1 as the minimum possible score (i.e., a) and 4 as the maximum possible score (i.e., b) on the 4- point original scale: ▪ 1 – Never ▪ 2 – Sometimes ▪ 3 – Usually ▪ 4 – Always -4) Measure (ACO Table 3-2 . Example of Scoring Transformation for Access to Specialists CASE -MIX ADJUSTED CALCULATION OF 0 -100 HYPOTHETICAL CONVERTED SCORE SCORE ACO MEAN SCORE ACO A 3.75 91.67 83.33 ACO B 3.5 75.00 3.25 ACO C CLAIMS -BASED DATA 3.3 CMS obtains the necessary Medicare Part A and Part B claims files from the CMS performance the rates for these Integrated Data Repository (IDR) and calculates measures for each ACO based on the algorithms specified in the MIF s, which are posted on the Shared Savings Program website . Calculations for each of these who are eligible for measures are conducted using t he ACO’s assigned beneficiaries the measures (refer to 3.1 Section y on assigned beneficiar for additional information eligibility ). For claims -based measures, ACOs do not need to collect or submit additional in such a data beyond normal billing activities. E ach of these measures are expressed lower performance rate indicates better quality (lower calculated results are way that a desired). 3.4 CMS WEB INTERFACE DA TA which is pre- populated with a sample of the the CMS Web Interface, An ACO will use ’s beneficiaries, as the mechanism for collecting and submitting clinical data to ACO -reported measures are aligned with the measure requirements for non-ACO CMS. ACO select the CMS that group practices Web Interface as a group practice reporting MIPS. As such, narrative descriptions and supplementary documents, mechanism for Program | Quality Measurement Methodology and Resources Medicare Shared Savings 20

22 which provide additional guidance related to the measures reported through the CMS 5 Web Interface, are available on the Quality Payment Program webpage. 3.4.1 ACCESSING AND REPORT ING DATA THROUGH THE CMS WEB INTERFACE nine-week ACOs are responsible for entering data into the CMS Web Interface during a period that occurs just after the close of the performance year quality data reporting (typica lly January through March of the calendar year following the performance year). ACO clinical data can be imported into the CMS Web Interface using health information or manually. ACOs will report data technology, via APIs, Excel upload, based on services f urnished during the performance year (January 1 through December 31) , unless otherwise noted in the supporting documents. CMS will not grant extensions to the reporting deadline. It is imperative that ACOs complete the data reporting and submission requirements in the CMS Web Interface by the deadline specified by CMS. ACOs will have the opportunity to export their data from the CMS Web Interface and download reports from the system during the reporting period and following the end of period. the data collection will be , as well as information on how to export data, reports More information on these available during the reporting period. 3.4.2 CMS WEB INTERFACE MEASURES SAMPLES The CMS Web Interface is pre-populated with measure-specific beneficiary samples and beneficiary demographic information. For certain measures, additional data are also pre-populated in the CMS Web Interface, such as visit dates and flu shot receipt (if available in claims data), and the three clinicians in the ACO that provided the most care to the beneficiaries . Since each CMS Web Interface measure has specific denominator requirements, each 6 measure has its own beneficiary sample. CMS makes reasonable efforts to include the same beneficiary in multiple measures in order to reduce reporting burden. The 7 measure samples are grouped into eight categories, or disease-related “modules.” 5 Please note that while the CMS Web Interface measure specifications note that three rates will be -17 (PREV- reported for ACO 10), the Shared Savings Program will use only the second rate for Shared Savings Program quality scoring. 6 For more information, refer to the CMS Web Interface Sampling Document, which will be available on the webpage each year. Quality Payment Program Resource Library 7 : CARE, DM Eight modules for 2018 , HTN, MH, PREV. Program | Quality Measurement Methodology and Resources 21 Medicare Shared Savings

23 pre-populated in the CMS Web Interface will be assigned rank s based on Beneficiaries the order in which they are sampled into a given measure module. For th e 2019 performance year, all ACOs are required to confirm and complete a minimum of 248 consecutive beneficiaries for each measure module, or confirm and complete all sampled beneficiaries if fewer than 248 are qualified for a module. Denominator inclusion and exclusion criteria for some measures may result in a sample of fewer than 248 beneficiaries. In this case, the ACO must report on 100 percent of the is conducted ing Oversampl to include more eligible beneficiaries for that measure. beneficiaries (e.g. up to 616 beneficiaries or 750 for PREV -13) than are needed to meet the reporting requirement of 248. 3.4.3 CMS WEB INTERFACE MEASURE PERFORMANCE RATES Once the submission period closes for CMS Web Interface-reported measures, CMS checks for complete reporting of these measures for each ACO and determines their performance rates. An ACO that fails to complete reporting by the CMS -specified deadline will be considered to have failed to meet the quality performance standard for the reporting year. 4 Quality Performance Scoring This section describes the phase-in to P4P, data sources, methods for calculating the benchmarks are applied to quality measure benchmarks for ACOs, and how these P4P measures. also discuss and calculated ACO’s quality score is es how an This section CMS determines an ACO’s eligibility for shared savings as part of performance how year financial reconciliation. Examples included in this section are based on the quality performance measure benchmarks for the 2019 . year 4.1 QUALITY MEASURE BEN CHMARKS Quality measure benchmarks are set for two years and are established by CMS prior to for which they apply. The benchmarks are used to score the first performance year quality score. ACO’s each measure performance, domain performance and calculate When a measure is added to the ACO quality measure set, it will be P4R for its first two s in use. It is also important to note that CMS maintains the authority performance year to revert measures from P4P to P4R when the measure owner determines the measure causes patient harm or no longer aligns with clinical practice. ES 4.1.1 BENCHMARK DATA SOURC CMS reporting years established benchmarks for the 2018 and 2019 using all available are FFS data Medic and applicable 2014, 2015, and 2016 (2015, 2016, and 2017 for . Th benchmarks were set in the 2019 update) measures where is includes: Medicare Shared Saving Program | Quality Measurement Methodology and Resources s 22

24 , and Next Quality data reported by Shared Savings Program , Pioneer Model ACOs ▪ Generation Model ACOs through the CMS Web Interface for the 2014 , 2015 , and ; and -27) performance years 2016 (2015, 2016, and 2017 for ACO CAHPS for ACOs ▪ Quality measure data collected from the and CAHPS for PQRS surveys administered for the 2014, 2015, and 2016 reporting years. (PQRS) uality data reported through the or Physician Quality Reporting System Q ▪ by physicians and groups of physicians through the CMS Web Interface, MIPS (2015, 2016, claims, or a registry for the 2014, 2015, and 2016 performance years , 8 9 -27) ; and 2017 for ACO T he quality measure benchmarks were calculated using ACO, group practice, and individual physician data aggregated to the practice or TIN level. (These calculations practice or TIN’s data if it had at least 20 cases in the denominator for the only include a or group practices that did not satisfy the Quality data for ACOs, providers, measure.) reporting requirements of the Shared Savings Program or PQRS were not /MIPS included in calculation of the benchmarks. 4.2 ING QUALITY MEASURE SCOR -specific measure data is collected and measure performance rates are Once ACO calculated, CMS determines whether all measures have been completely reported. CMS then determines how many points an ACO earned on each measure. An ACO can earn a maximum of two points on each measure. : Maximum ▪ P4R measures points will be earned on all measures if all measures reported through the are completely reported and a CMS- CMS Web Interface approved vendor administers the CAHPS for ACOs Survey on behalf of the ACO and transmits the data to CMS . Incomplete reporting on any CMS Web Interface measure will result in zero points and failure to all CMS Web Interface measures for . Similarly, if a CAHPS for ACOs meet the quality standard for the performance year Survey is not administered and no data is transmitted to CMS, zero points will be earned for all Patient/Caregiver Experience measures and the ACO will fail to meet the quality standard for the performance year . ’s ▪ P4P measures : Points are earned for each measure based on the ACO Table , as shown in red to measure-specific benchmarks 4-1 compa performance 8 CMS did not use data submitted via the PQRS Qualified Clinical Data Registry (QCDR) and in 2014 electronic reporting options due to data integrity issues. specific mechanism exclusions Other measure- -by-case basis. were also made on a case 9 -level data -17 was respecified in 2018. As a result, we recalculated the measure using patient ACO submitted by ACOs and group practices through the CMS Web Interface in 2014, 2015, and 2016 and created benchmarks using solely that data. Program | Quality Measurement Methodology and Resources Medicare Shared Savings 23

25 . If no beneficiaries are eligible for a measure’s denominator, the ACO will earn below full points on the measure. Incomplete reporting on any CMS Web Interface measure will result in zero points for all CMS Web Interface measures and the ACO will fail to meet the quality standard for the performance year . Similarly, if a CAHPS for ACOs Survey is not administered and/or no data is transmitted to CMS, zero points will be earned for all Patient/Caregiver Experience measures and the ACO will fail to meet the quality standard for the performance year . Benchmark Table Level Each 4-1 . Points Associated with Meeting or Passing BENCHMARK POINTS ASSOCIATED WI TH MEETING OR PASSING BENCHMARK < 30th percentile No points 1.10 30th percentile 40th percentile 1.25 50th percentile 1.40 1.55 60th percentile 70th percentile 1.70 1.85 80th percentile 90th percentile 2.00 Example -13 An ACO earns a performance rate score of 82.75 on measure ACO (Falls: the is at or above .75 of 82 Screening for Future Fall Ris core k). The performance rate s th th 80 percentile, so the ACO will receive 1.85 points ( percentile and below the 90 Refer to table above). that this example is based on quality measure benchmarks for the Please n ote 9 performance years. 201 2018/ corresponding For most measures, the higher the level of performance, the higher the number of quality points. However, it is important to note that for some ACO quality assessing the occurrence of undesirable outcomes, a lower score represents measures pecifically, better performance. S Program | Quality Measurement Methodology and Resources Medicare Shared Savings 24

26 -38 (All-Cause ▪ ACO -8 (Risk -Standardized All -Condition Readmission) and ACO Unplanned Admissions for Patients with Multiple Chronic Conditions) capture admissions and readmissions that are preventable events ▪ ACO -27 (Diabetes Mellitus: Hemoglobin A1c Poor Control) captures beneficiaries whose HbA1c is not in control , and -43 ACO ▪ captures the ratio of (Ambulatory Sensitive Condition Acute Composite) observed admissions to expected admissions . 4.3 QUALITY MEASURE DOMA IN SCORING 4.3.1 REWARD SCORING QUALITY IMPROVEMENT Starti ng with Performance Year 2015, CMS introduced a Quality Improvement Reward in each domain s ACOs to earn up to four additional points if they show that allow statistically significant improvement in their performance on quality measures from one next. CMS will not deduct any points from an ACO’s quality score year to the if the ACO is adapted did not improve on a quality measure. The Quality Improvement Reward program, which has developed and R ating -Star Five from the Medicare Advantage 10 implemented a methodology for measuring quality improvement . ACOs in Year Performance 2 of their first agreement period and beyond will be eligible to earn a Reward. Quality I mprovement T he steps used to calculate the Quality Improvement are outlined below . Reward for each domain Step 1. for each measure. CMS s at the change in performance look For each ACO, Step 2. CMS determines whether the change in performance was statistically significant (either improved or declined) at a 95 percent confidence level fo r each measure. Step 3. CMS sums the number of measures with a statistically significant Within each domain, improvement and subtract s the number of measures with a statistically significant decline to determine net improvement . 10 For more information on the Medicare Advantage Five -Star Rating Methodology, refer to : http://www.cms.gov/Medicare/Prescription- Drug -Coverage/PrescriptionDrugCovGenIn/Downloads/2015 - 2015.zip 16- Medicare -v4- -D- -Data -Ratings -Star Part -C- and Medicare Shared Savings Program | Quality Measurement Methodology and Resources 25

27 Step 4. improvement in each domain by the number of eligible s the measures in CMS divide net This score is used to score . the domain to calculate the d omain improvement determine the Quality Improvement Reward. In the event that an ACO demonstrates a statistically significant decline in a measure th from one year to the next, but still scores above 90 percent (or above the 90 percentile benchmark in the case of certain claims -based measures) in both years, CMS will consider this “no change” in perfor mance (instead of a significant decline) when score. improvement Medicare Advantage omain the calculating the d This aligns with ” provision in the five-star rating methodology. Furthermore, ACOs will be “hold harmless “held harmless” (i.e., changes between years will neither be considered a significant nor a significant decline) in the following situations: improvement If the ACO did not completel y report measures through the CMS Web Interface in ▪ the previous year, none of the CMS Web Interface measures will be considered a significant improvement or a significant decline. If the ACO did not field a CAHPS for ACO Survey in the previous year, none of the ▪ CAHPS for ACO Survey measures will be considered a significant improvement or a significant decline. ▪ If the ACO has a denominator of zero on a measure in either the current year or the previous year, the change in performance will neither be considered a significant improvement nor a significant decline. in a given Note that only measures that are not new to the Shared Savings Program year are used in this calculation. For example, only measures collected in both 2019 Year 2018 and Performance Year Performance are included in the domain improvement score calculation for 2019 . Step 5. domain improvement score according CMS assigns quality improvement points to the to the point system listed . below 4-2 in Table Program | Medicare Shared Savings Quality Measurement Methodology and Resources 26

28 Table . Crosswalk between Improvement Measure Score and Quality Improvement Points 4-2 DOMAIN QUALITY IMPROVEMENT POINT S IMPROVEMENT SCORE 90+ percent 4.0 points 80+ percent 3.56 points 70+ percent 3.12 points 60+ percent 2.68 points 50+ percent 2.24 points 40+ percent 1.8 points 1.36 point 30+ percent 20+ percent 0.92 point 10+ percent 0.48 point < 10 percent No points 4.3.2 DOMAIN SCORE Table 4-3 below shows the maximum possible points that may be earned by an ACO in each domain and overall. 4-3 Table 9) 201 the Quality Performance Standard ( ithin . Total Points for Each Domain W TOTAL MEASURES NUMBER OF TOTAL DOMAIN DOMAIN POSSIBLE FOR SCORING INDIVIDUAL WEIGHT MEASURES POINTS PURPOSES Patient/Caregiver 25% 20 10 10 individual summary survey measures Experience 8 Care Coordination/ 25% 4 4 measures Patient Safety Preventive Health 6 6 measures 12 25% At-Risk Population 3 3 individual measures 6 25% Total in all Domains 23 23 46 100% The quality improvement reward points (discussed in Section 4.3.1) are added to the 4.2), total points earned in a domain for measure performance (discussed in Section and this combined total of points cannot exceed the maximum points that are possible 4-3 Table in that domain, as identified in combined total of points , the . For each domain Medicare Shared Savings Program | Quality Measurement Methodology and Resources 27

29 is divided by the number of possible points for the domain and multiplied by 100 t o create a percentage. This results in a domain score for each of the four domains. Example: There are 12 possible points in the Preventive Health domain. If an ACO earns : The total score will be 100 percent. Note that although the total adds up to 13.79, the total points earned cannot exceed the maximum possible points in the domain. 4.4 QUALITY SCORE score has been calculated for each domain using the methodologies After a domain four domain scores are weighted equally to calculate one described above, the quality 11 score. Table 4-4 below shows an example of an ACO in the first year of their first ed agreement period (P4R) that completely and accurately report on all measures collected via the CMS Web Interface and admini the CAHPS for ACOs Survey stered through a CMS -approved vendor. As a result, the ACO earns full points on all measures and earns domain scores of 100 percent for each domain. Completely that Reported Table 4-4 . Example of D omain Scores for an ACO in Performance Year 1 POINTS EARNED/ DOMAIN TOTAL POSSIBLE POINTS FOR COMPLETE REPORTING DOMAIN ACO IN FIRST BY DOMAIN PERFORMANCE YEAR SCORE Patient/Caregiver 20/20 Completely reported on all 100% measures Experience Care 100% 8/8 Completely reported on all Coordination/Patient measures Safety Completely reported on all Preventive Health 12/12 100% measures 11 d to th e hundredths p Althoug in scor es ar e shown rounde h doma lac e in this document , un rounde d alculat d to c e use es ar in scor ty score. e th e quali doma Program | Quality Measurement Methodology and Resources Medicare Shared Savings 28

30 POINTS EARNED/ TOTAL DOMAIN POSSIBLE POINTS FOR ACO IN FIRST COMPLETE REPORTING DOMAIN BY DOMAIN PERFORMANCE YEAR SCORE At-Risk Population 6/6 Completely reported on all 100% measures — 100% Quality Score — Note . — = not applicable : Based on quality measures in effect in 2019 As shown in Table 4-5 below , for an ACO beyond the first year of their first agreement period that earned a domain score of 100 percent on the Preventive Health domain, 94.00 percent on the Patient/Caregiver Experience domain, 92.50 percent on the Care Coordination/Patient Safety domain, and 90.00 percent on the At -Risk Population Domain, the quality score is 94.13 percent. omain O Beyond Performance Year 1 Scores for an AC Table 4-5 . Example of D DOMAIN FOR POINTS EARNED TOTAL POSSIBLE DOMAIN ACO BEYOND POINTS SCORE PERFORMANCE YEAR 1 .80 % 94.00 18 20 Patient/Caregiver Experience Care Coordination/Patient 7.40 8 92.50 % Safety 12 Preventive Health 12 100 .00 % 90.00 6 5.40 At-Risk % Population Quality score 94.13% performance year quality measures. Note: Example uses 2019 Quality Score = 94.0% x 0.25 + 92.50% x 0.25 + 100% x 0.25 + 90.0% x 0.25 = 94.13% 4.5 QUALITY MEASURES VAL IDATION AUDIT quality score may be impacted by the Quality Measures Validation (QMV) An ACO’s The ACO’s final quality score is used in determining the ACO’s final sharing rate audit. 1.4. es as described in Section for savings and loss Each year, at the discretion of CMS, a subset of ACOs are selected for a QMV audit. its ACO will be asked to substantiate, using information from During the QMV audit, an beneficiaries’ medical records, what was entered into the CMS Web Interface for a CMS will calculate an overall QMV sample of beneficiaries and a sample of measures. audit match rate for each audited ACO. The overall QMV audit match rate will be equal Medicare Shared Savings Program | Quality Measurement Methodology and Resources 29

31 to the total number of audited records that match the information reported in the CMS divided by the total number of records audited. If Web Interface the audit concludes that the overall audit match rate between the quality data reported through the CMS Web Interface and the medical records is less than 80 percent, absent unusual circumstances, CMS will adjust the ACO’s quality score proportional to the ACO’s audit performance (42 CFR § 425.500(e)(2)) . The quality score for ACOs have failed the audit will be adjusted by one percent for that each percentage point difference between the ACO’s QMV Audit match rate and 80 percent . In other words, the final quality score for ACOs that have failed the audit will be calculated as follows: ]) QMV Audit Match Rate − [80% − Quality Score × (100% If, at the conclusion of the audit process, CMS determines that the ACO has passed the audit (match rate of 80 percent or higher), but that there is an audit match rate of less required subject to compliance action such as being than 90 percent, the ACO may be to submit a corrective action plan (CAP) 42 CFR under § 425.216 for CMS approval 42 CFR § 425.500(e)(3) (per ). COMPLIANCE 4.6 CMS may take compliance action if the ACO fails to meet the minimum attainment level Compliance actions may on at least 70 percent of measures in one or more domains include receiving a warning letter or being subject to a CAP or a special monitoring plan. Also, failure to report quality measure data accurately, completely, and timely may subject the ACO to termination. Program | Quality Measurement Methodology and Resources 30 Medicare Shared Savings

32 5 Alignment with the Quality Payment Program The Quality Payment Prog ram rewards value and outcomes in one of two ways through the Merit -Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). CMS aligned quality reporting requirements for the Shared Savings Program with the n an effort to reduce reporting burden. Quality Payment Program i CERTIFIED ELECTRONIC HEALTH RECORD 5.1 TECHNOLOGY (CEHRT) USE Beginning Performance Year 2019, ACOs will be required to certify annually, in the form and manner specified by CMS, that: ▪ at least 50 percent of the ECs use the version of CEHRT required by the Quality Payment Program (2015 Edition for Performance Year 2019) for ACOs in Track 1 (i.e., MIPS APMs) and BASIC track Levels A -D of the ECs us e the version of CEHRT required by the Quality percent at least 75 ▪ Payment Program (2015 Edition for Performance Year 2019) for Track 2, ACOs in Track 3, Track 1+ Model and BASIC track Level E and ENHANCED track (i.e., Advanced APMs) , which is the threshold established under the Quality Payment Program) for Advanced AP Ms . This certification is not a measure that is used to calculate the ACO’s annual quality score. Participants of MIPS APMs and their ECs will also need to continue submitting MIPS Promoting Interoperability data, in the form and manner specified by MIPS, for MIPS APM scoring purposes. For more information on how participating TINs must report PI Quality Payment Program webpage please visit the data, or contact the Quality Payment Program Service Center ( [email protected] ). g There are a number of resources available to Shared Savings Program ACOs, includin the following guides: ▪ Medicare Shared Savings Program & MIPS Interactions Performance Category Scoring Web Interface Performance Year 2019 ▪ Quality Reporters under the APM Scoring Standard Scores for Improvement Activities in MIPS APMs in the 201 ▪ 9 Performance Period Program | Medicare Shared Savings Quality Measurement Methodology and Resources 31

33 List of Acronyms Acronym Definition ACO Accountable Care Organization AHRQ Agency for Healthcare Research and Quality APM Alternative Payment Model CAHPS Consumer Assessment of Healthcare Providers and Systems corrective action plan CAP Certified EHR Technology CEHRT CG -CAHPS CAHPS Clinician & Group Survey CHIP Children’s Health Insurance Program CMS Centers for Medicare & Medicaid Services ECs eligible clinicians EHR Electronic Health Record -service -for fee FFS hypertension HTN IDR Integrated Data Repository MACRA Medicare Access and Children’s Health Insurance Program Reauthorization Act MIF Measure Information Form MIPS Merit -Based Incentive Payment System NPI National Provider Identifier -performance P4P pay-for -reporting pay-for P4R PFS Physician Fee Schedule PI Promoting Interoperability PQI Prevention Quality Indicator PQRS Physician Quality Reporting System PY performance y ear Quality Measures Validation QMV summary survey measure SSM taxpayer identification number TIN Program | Quality Measurement Methodology and Resources Medicare Shared Savings 32

Related documents

DoD7045.7H

DoD7045.7H

DoD 7045.7-H EPARTMENT OF D EFENSE D F UTURE Y EARS D EFENSE P ROGRAM (FYDP) S TRUCTURE Codes and Definitions for All DoD Components Office of the Director, Program Analysis and Evaluation A pril 2004

More info »
435 441 458 467r e

435 441 458 467r e

WT/DS435/R, WT/DS441/R WT/DS458/R, WT/DS467/R 28 June 2018 Page: (18 - 1/884 4061 ) Original: English AUSTRALIA CERTAIN MEASURES CON CERNING TRADEMARKS, – PACKAGING IONS AND OTHER PLAIN GEOGRAPHICAL I...

More info »
Implementation Handbook For The Convention On The Rights Of The Child

Implementation Handbook For The Convention On The Rights Of The Child

IMPLEMENTATION HANDBOOK FOR THE CONVENTION ON THE RIGHTS OF THE CHILD FULLY REVISED THIRD EDITION IMPLEMENTATION HANDBOOK IMPLEMENTATION HANDBOOK FOR THE CONVENTION ON THE FOR THE CONVENTION ON THE RI...

More info »
Thriving on Our Changing Planet: A Decadal Strategy for Earth Observation from Space

Thriving on Our Changing Planet: A Decadal Strategy for Earth Observation from Space

TIONAL ACADEMIES PRESS THE NA This PDF is available at http://nap.edu/24938 SHARE     Thriving on Our Changing Planet: A Decadal Strategy for Earth Observation from Space DET AILS 700 pages | 8.5 ...

More info »
oldnew 11.dvi

oldnew 11.dvi

C ́edric Villani O ptimal transport, old and new June 13, 2008 Springer Berlin Heidelberg NewYork Hong Kong London Milan Paris Tokyo

More info »
Department of Defense   Law of War Manual (June 2015)

Department of Defense Law of War Manual (June 2015)

D E A R T M E N T O F D E F E N S E P N A L O F W A R M A W U A L J U N E 2 0 1 5 O F F I C E O F G E N ER A L C O U N S E L D P A R T M E N T E O F D E F E N S E

More info »
vol9 organic ligands

vol9 organic ligands

C HERMODYNAMICS HEMICAL T OMPOUNDS AND C OMPLEXES OF OF C U, Np, Pu, Am, Tc, Se, Ni and Zr O ELECTED WITH RGANIC L IGANDS S Wolfgang Hummel (Chairman) Laboratory for Waste Management Paul Scherrer Ins...

More info »
UNSCEAR 2008 Report Vol.I

UNSCEAR 2008 Report Vol.I

This publication contains: VOLUME I: SOURCES SOURCES AND EFFECTS Report of the United Nations Scientific Committee on the Effects of Atomic Radiation to the General Assembly OF IONIZING RADIATION Scie...

More info »
6510020586

6510020586

Experion MX CD Controls R701.1 User Manual 6510020586 Rev 01

More info »
MER United States 2016

MER United States 2016

Anti-money laundering and counter-terrorist financing measures United States Mutual Evaluation Report December 2016

More info »
Strong Start for Mothers and Newborns Evaluation: Year 5 Project Synthesis Volume 1: Cross Cutting Findings

Strong Start for Mothers and Newborns Evaluation: Year 5 Project Synthesis Volume 1: Cross Cutting Findings

g Star t f or Mothe rs and Newbor ns Evaluation: Stron YNTHESIS ROJECT S AR 5 P YE Volume 1 indings -Cutting F ross : C Prepared for: ss Caitlin Cro -Barnet Center fo HS nd Medicaid Innovation, DH r M...

More info »
mar19 medpac entirereport sec

mar19 medpac entirereport sec

MARCH 2019 Report to the Congress: Medicare Payment Policy REPOR G RESS T TO THE CON Medicare Payment Policy | March 2019 Washington, DC 20001 425 I Street, NW • Suite 701 • (202) 220-3700 • Fax: (202...

More info »
2018 Physical Activity Guidelines Advisory Committee Scientific Report

2018 Physical Activity Guidelines Advisory Committee Scientific Report

2018 Physical Activity Guidelines Advisory Committee Scientific Report To the Secretary of Health and Human Services

More info »
Best Practices Handbook for the Collection and Use of Solar Resource Data for Solar Energy Applications

Best Practices Handbook for the Collection and Use of Solar Resource Data for Solar Energy Applications

Best Practices Handbook for the Collection and Use of Solar Resource Data for Solar Energy Applications 1 1 1 1 2 A. Dobos, S. , Wilbert, A. Habte, S. Kurtz, M. Sengupta 3 6 4 7 5 T. ard, D. Myers, C....

More info »
seea cf final en

seea cf final en

System of Environmental-Economic Accounting 2012 Central Framework Food and European Organisation for The World Bank United International Economic Co-operation Monetary Commission Agriculture Nations ...

More info »
Measuring the Information Society Report

Measuring the Information Society Report

Internati onal Measuring Telecommunicati on Union the Information Place des Nati ons CH-1211 Geneva 20 Switzerland Society Report ISBN: 978-92-61-21431-9 2016 6 4 0 4 3 3 9 6 1 2 1 4 2 1 9 7 9 8 Print...

More info »
Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation

Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation

MANAGING THE RISKS OF EXTREME EVENTS AND DISASTERS TO ADVANCE CLIMATE CHANGE ADAPTATION SPECIAL REPORT OF THE INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE

More info »
Grant Lake Hydroelectric Project—FERC Project No. 13212 005

Grant Lake Hydroelectric Project—FERC Project No. 13212 005

Office of Energy Projects May 2019 –0283F FEIS FERC/ ENVIRONMENTAL IMPACT STATEMENT FINAL FOR HYDROPOWER LICENSES Hydroelectric Project —FERC Project No. 13212- 005 Grant Lake Alaska Federal Energy Re...

More info »
AcqKnowledge 4 Software Guide

AcqKnowledge 4 Software Guide

® Acq 4 Software G uide Knowledge Check BIOPAC.COM > Sup port > Manuals for updates For Life Science Research Applications Data Acquisition and Analysis with BIOPAC Hardware Systems Reference Manual f...

More info »