Reimbursement

News

Changes in Quality Measures for Medicare

July 22, 2014


The Centers for Medicare and Medicaid (CMS) is proposing to change about one third of the quality measures used for judging performance of ACOs participating in the Medicare Shared Savings program. It is also proposing to adjust its quality scoring strategy by rewarding year-to-year quality improvement for such ACOS.


The recommended changes were included the agency’s recent proposal for updating Medicare payment for physician services in Calendar Year 2015.
 

CMS is proposing to retire eight current quality measures while adding 12 new ones, bringing the total number of quality measures used to judge ACO performance from 33 to 37. New measures to be added would focus on avoidable admissions for patients with multiple chronic conditions, heart failure, and diabetes; depression remission at 12 months; all cause readmissions to a skilled nursing facility; and stewardship of patient resources (the measure asks patients whether the care team talked with them about prescription medicine costs). In addition the existing composite measures for diabetes and coronary artery disease would be updated.

 

CMS is proposing to revise its quality scoring strategy to reward ACOs that make year-to-year improvements in quality performance scores on individual measures. It would add a quality improvement measure that adds bonus points for providers that show quality improvement in each of the four quality measure groupings—patient/caregiver experience, care coordination/safety, preventive health, and clinical care for at-risk populations.
 

CMS will accept comments on the proposed rule until September 2, 2014. The final rule will go into effect on January 1, 2015.