The CMS won't use performance on a smoking cessation measure it significantly changed as part of the Medicare Shared Savings Program for 2018 after strong opposition from accountable care organizations.
In a newsletter this week to ACOs, the CMS said ACO-17, a measure used to screen patients for tobacco use and then provide a cessation intervention for those who smoke, will only be counted as a pay-for-reporting measure instead of pay-for-performance measure to account for changes the agency made to it during the 2018 quality reporting period.
The agency said given the changes, "the measure does not have a valid benchmark that provides a true and accurate depiction of actual performance."
The change also applied to the Next Generation ACO Model, which use the same measure set as the Medicare Shared Savings Program.
In a statement, the National Association of ACOs applauded the decision but added that the CMS should not make changes to the program without stakeholder feedback and notification to participants.
"ACOs want to help patients quit smoking, but CMS should also be fair in setting requirements for how that should be done," the association said.
When the measure change was initially discovered by ACOs in the spring, they publicly opposed the decision, arguing it was unexpected and could negatively impact their performance, and thus their ability to achieve bonuses.
At the time, the ACOs urged the CMS to make the measure pay-for-reporting for two performance years given the significant changes. The CMS will typically only make measures pay-for-reporting for two years if they are new, but they have done it for old measures that underwent substantial changes. For instance, the agency did this for ACO-11, a measure for electronic health record use.
In the newsletter, the CMS only mentioned the measure will be counted as pay-for-reporting for the 2018 performance year so it's still unclear if the CMS will count it as pay-for-performance in 2019.
The CMS also didn't mention any modifications to how the measure was changed, which providers opposed as well.
The measure changed from including all patients getting screened regardless of tobacco use to just patients who screen positive for smoking. Additionally, measure compliance is only achieved if the cessation intervention occurs each time the patient is screened. Providers argue that's redundant, especially if patients see their doctors frequently.
Performance on quality measures is one way the CMS determines bonuses and losses ACOs receive. In 2018, there were 31 quality measures for the program.
