Limited data shows quality of care at Medicare ACOs is all over the map

CMS has only released quality on five performance measures

CMS has yet to release comprehensive data on the care quality provided by more than 300 Medicare ACOs, but the limited available data suggest that performance improvements may not be universal, Modern Healthcare's Melanie Evans writes.

Where the Medicare ACOs are, 2014 edition

Show me the data?

CMS collects data on 33 quality measures for all participants in its Medicare Shared Saving Program ( MSSP) and its Pioneer ACO program, and original ACO rules stated that CMS would release data on 22 of the measures to "hold ACOs accountable and contribute to the dialogue on how to drive improvement and innovation in health care."

But so far, the agency has released results for only five measures for the 145 ACOs that began participating in the MSSP in 2012.

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"If you're going to collect 33 (quality) measures, I don't know why it is that the public doesn't have access to that information," says Robert Berenson, an Urban Institute senior fellow and Medicare policy expert. He adds that giving the public access to the data gives the ACO program "credibility and accountability" and could help Medicare beneficiaries decide whether to join an ACO.

Hospitals and physicians may feel nervous about publicly reporting data and CMS officials may be using the limited release of information as a way to "get them comfortable," says Kavita Patel, managing director for clinical transformation and delivery at the Brookings Institution's Engelberg Center for Health Care Reform.

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What we do know about ACO quality

The data on the five performance measures that CMS has released on MSSP quality show a link between quality performance and cost savings. ACOs that earned shared savings reported higher scores than ACOs that did not receive savings on three out of four measures assessing diabetes control.

Meanwhile, one Pioneer ACO chose to release its quality performance results: Allina Health in Minneapolis. The six-hospital system published its 2012 quality performance and compared it to the highest, lowest, and median performance figures for all 145 ACOs in 2012.

Allina's report revealed sharp variations in preventive care and disease management quality measures across ACOs. For instance:

  • Influenza immunization ranged from 42% at the 30th percentile of performance to 71% at the 90th percentile;
  • Colorectal cancer screening rates ranged from 43% at the 30th percentile to 87% at the 90th percentile; and
  • Medication reconciliation rates—the percentage of patients who review their prescriptions with physicians within 60 days of discharge—ranged from 70% at the 30th percentile to 99.7% at the 90th percentile.

The severe variation can be attributed to first-year confusion over reporting and inexperience with new measures, leaders say (Evans, Modern Healthcare, 5/3 [subscription required]).

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