Healthcare Business News

Physician fee schedule would modify Medicare ACO measures

By Melanie Evans
Posted: July 3, 2014 - 8:15 pm ET

The CMS plans to increase the number of quality measures in the Medicare Shared Savings program for accountable care organizations and put greater emphasis on outcomes.

The changes, included in the 2015 Medicare physician fee schedule (PDF), would increase the number of quality measures from 33 to 37. ACOs must meet quality performance targets to earn bonuses in the program, which includes nearly 350 organizations and is scheduled to expand in January. The program was launched under a provision of the Patient Protection and Affordable Care Act. If adopted in the final rule, the changes would go into effect Jan. 1.

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The new measures include whether patients say providers educated them about the cost of medications; the rate of patients who are admitted to a skilled-nursing facility within 30 days of leaving the hospital; and all-cause unplanned readmissions for patients with diabetes, heart failure or multiple chronic conditions.

The CMS also proposed a replacement measure for medication management and a modification to its requirement for electronic health-record adoption and suggested removing some measures related to the treatment of diabetes, ischemic vascular disease and coronary artery disease.

The changes are intended to bring the regime in line with changes to clinical practice and streamline reporting. The agency also solicited comments on future quality measures to address care coordination, quality in nursing homes and other settings, utilization, health outcomes, prevention and public health and measures tailored to care for the frail elderly.

The rule would also add a new incentive for ACOs tied to quality improvement. ACOs receive bonuses only when they reach targets for quality and reduced healthcare spending. ACOs that score higher on quality measures already receive larger bonuses, but the proposed rule would offer ACOs an award based on annual quality improvement, similar to quality improvement awards for Medicare Advantage plans.

The proposal, released Thursday afternoon, won quick praise from Premier, a company that provides supply-chain and performance-improvement services to hospitals. “As we learned piloting the hospital value-based purchasing program, rewarding improvement is an effective way to incent ongoing work to reach the MSSP quality goals,” Premier spokesman Blair Childs said.

Follow Melanie Evans on Twitter: @MHmevans

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