Medicare unveils changes ahead for its ACOs

Agency wants to use four new quality measures

CMS has proposed increasing the number of quality measures used in the Medicare Shared Savings Program (MSSP) for ACOs, according to the proposed 2015 Medicare physician fee schedule released Thursday.

The measures would place a greater emphasis on patient outcomes.

Specifically, the number of quality measures used to assess ACOs would increase from 33 to 37. ACOs would need to meet the quality performance goals to earn bonus payments under the program. The new measures would include:

  • Whether patients say providers informed them about treatment costs;
  • The rate of patients who are admitted to skilled nursing facilities within 30 days of being discharged from a hospital; and
  • Unplanned readmissions for patients with diabetes, heart failure or more than one chronic condition for any reason.

In addition, CMS proposed:

  • Replacing a measure dealing with medication management;
  • Changing a requirement that ACOs adopt electronic health records; and
  • Eliminating some measures dealing with treatments for coronary artery disease, diabetes and ischemic vascular disease.

According to Modern Healthcare, the changes would bring the measures in line with those used in clinical practices and help simplify reporting.

Year one: Just one in four shared-savings ACOs earned bonus pay

Also in the proposal, CMS suggested adding new quality incentives for ACOs. The incentives would:

  • Require ACOs to meet certain quality targets while reducing health care spending in order to receive bonus payments; and
  • Allow ACOs to receive awards based on annual quality improvement.

Meanwhile, CMS requested comments on future quality measures for:

  • Care coordination;
  • Health outcomes;
  • Nursing home quality;
  • Prevention;
  • Elderly public health; and
  • Utilization (Evans, Modern Healthcare, 7/3 [subscription required]).

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