DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: Accountable Care Organizations FACT SHEET http://www.cms.gov/sharedsavingsprogram Overview On October 20, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the 'HSDUWPHQW RI +HDOWK +XPDQ 6HUYLFHV ++6 ¿QDOL]HG QHZ UXOHV XQGHU WKH $IIRUGDEOH &DUH $FW to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients WKURXJK $FFRXQWDEOH &DUH 2UJDQL]DWLRQV $&2V $&2V FUHDWH LQFHQWLYHV IRU KHDOWK FDUH SURYLGHUV WR ZRUN WRJHWKHU WR WUHDW DQ LQGLYLGXDO SDWLHQW DFURVV FDUH VHWWLQJV ± LQFOXGLQJ GRFWRU¶V RI¿FHV KRVSLWDOV DQG ORQJWHUP FDUH IDFLOLWLHV 7KH 0HGLFDUH 6KDUHG 6DYLQJV 3URJUDP 6KDUHG 6DYLQJV 3URJUDP ZLOO UHZDUG $&2V WKDW ORZHU WKHLU JURZWK LQ KHDOWK FDUH FRVWV ZKLOH PHHWLQJ SHUIRUPDQFH VWDQGDUGV RQ TXDOLW\ RI FDUH DQG SXWWLQJ SDWLHQWV ¿UVW 3URYLGHU SDUWLFLSDWLRQ LQ DQ $&2 LV SXUHO\ YROXQWDU\ ,Q GHYHORSLQJ WKLV ¿QDO UXOH &06 ZRUNHG FORVHO\ ZLWK DJHQFLHV DFURVV WKH )HGHUDO JRYHUQPHQW WR ensure a coordinated and aligned inter- and intra-agency effort to facilitate implementation of the Shared 6DYLQJV 3URJUDP &06 HQFRXUDJHV DOO LQWHUHVWHG SURYLGHUV DQG VXSSOLHUV WR UHYLHZ WKLV ¿QDO UXOH DQG FRQVLGHU SDUWLFLSDWLQJ LQ WKH 6KDUHG 6DYLQJV 3URJUDP 7KLV IDFW VKHHW GHVFULEHV WKH TXDOLW\ PHDVXUHV DQG WKH PHWKRG IRU VFRULQJ DQ $&2¶V SHUIRUPDQFH IRU SXUSRVHV RI PHHWLQJ WKH TXDOLW\ SHUIRUPDQFH VWDQGDUG XQGHU WKH 6KDUHG 6DYLQJV 3URJUDP ACO Final Quality Measures and Performance Scoring Methodology Quality Measures: 7KH ¿QDO UXOH DGRSWV LQGLYLGXDO PHDVXUHV RI TXDOLW\ SHUIRUPDQFH WKDW ZLOO EH XVHG WR GHWHUPLQH LI DQ $&2 TXDOL¿HV IRU VKDUHG VDYLQJV 7KHVH PHDVXUHV VSDQ IRXU TXDOLW\ GRPDLQV 3DWLHQW ([SHULHQFH RI &DUH &DUH &RRUGLQDWLRQ3DWLHQW 6DIHW\ 3UHYHQWLYH +HDOWK DQG $W5LVN 3RSXODWLRQ 7KH OLVW RI PHDVXUHV LV LQFOXGHG DV DQ DSSHQGL[ WR WKLV IDFW VKHHW 1 ICN 907407 October 2011
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DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid Services
Improving Quality of Care for Medicare Patients:
Accountable Care OrganizationsFACT SHEET http://www.cms.gov/sharedsavingsprogram
Overview
On October 20, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the 'HSDUWPHQW�RI�+HDOWK��+XPDQ�6HUYLFHV��++6���¿QDOL]HG�QHZ�UXOHV�XQGHU�WKH�$IIRUGDEOH�&DUH�$FW�to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients WKURXJK�$FFRXQWDEOH�&DUH�2UJDQL]DWLRQV��$&2V���$&2V�FUHDWH�LQFHQWLYHV�IRU�KHDOWK�FDUH�SURYLGHUV�WR�ZRUN�WRJHWKHU�WR�WUHDW�DQ�LQGLYLGXDO�SDWLHQW�DFURVV�FDUH�VHWWLQJV�±�LQFOXGLQJ�GRFWRU¶V�RI¿FHV��KRVSLWDOV��DQG�ORQJ�WHUP�FDUH�IDFLOLWLHV��7KH�0HGLFDUH�6KDUHG�6DYLQJV�3URJUDP��6KDUHG�6DYLQJV�3URJUDP��ZLOO�UHZDUG�$&2V�WKDW�ORZHU�WKHLU�JURZWK�LQ�KHDOWK�FDUH�FRVWV�ZKLOH�PHHWLQJ�SHUIRUPDQFH�VWDQGDUGV�RQ�TXDOLW\�RI�FDUH�DQG�SXWWLQJ�SDWLHQWV�¿UVW��3URYLGHU�SDUWLFLSDWLRQ�LQ�DQ�$&2�LV�SXUHO\�YROXQWDU\�
,Q�GHYHORSLQJ�WKLV�¿QDO�UXOH��&06�ZRUNHG�FORVHO\�ZLWK�DJHQFLHV�DFURVV�WKH�)HGHUDO�JRYHUQPHQW�WR�ensure a coordinated and aligned inter- and intra-agency effort to facilitate implementation of the Shared 6DYLQJV�3URJUDP�
,Q�GHYHORSLQJ�WKH�¿QDO�UXOH��&06�OLVWHQHG�WR�LQGXVWU\�FRQFHUQV�DERXW�IRFXVLQJ�PRUH�on outcomes and considered a broad array of measures that would help to assess DQ�$&2¶V�VXFFHVV�LQ�GHOLYHULQJ�KLJK�TXDOLW\�KHDOWK�FDUH�DW�ERWK�WKH�LQGLYLGXDO�DQG�SRSXODWLRQ�OHYHOV��&06�DOVR�VRXJKW�WR�DGGUHVV�FRPPHQWV�WKDW�VXSSRUWHG�DGRSWLQJ�IHZHU�WRWDO�PHDVXUHV�WKDW�UHÀHFW�SURFHVVHV�DQG�RXWFRPHV��DQG�DOLJQLQJ�WKH�PHDVXUHV�ZLWK�WKRVH�XVHG�LQ�RWKHU�TXDOLW\�UHSRUWLQJ�SURJUDPV��VXFK�DV�WKH�3K\VLFLDQ�4XDOLW\�5HSRUWLQJ�6\VWHP�
WKDW�LV�D�VXUYH\�PHDVXUH�RI�IXQFWLRQDO�VWDWXV��&06�ZLOO�NHHS�WKH�PHDVXUH�LQ�SD\�IRU�UHSRUWLQJ�VWDWXV�IRU�WKH�HQWLUH�DJUHHPHQW�SHULRG��7KLV�ZLOO�DOORZ�$&2V�WR�JDLQ�H[SHULHQFH�ZLWK�WKH�measure and will provide important information to them on improving the outcomes of their SDWLHQW�SRSXODWLRQV�
CMS will add the points earned for the individual measures within each domain and divide by the total SRLQWV�DYDLODEOH�IRU�WKH�GRPDLQ�WR�GHWHUPLQH�HDFK�RI�WKH�IRXU�GRPDLQ�VFRUHV��7KH�GRPDLQV�ZLOO�EH�ZHLJKWHG�HTXDOO\�DQG�VFRUHV�DYHUDJHG�WR�GHWHUPLQH�WKH�$&2¶V�RYHUDOO�TXDOLW\�SHUIRUPDQFH�VFRUH�DQG�VKDULQJ�UDWH��$&2V�ZRXOG�QHHG�WR�DFKLHYH�WKH�PLQLPXP�DWWDLQPHQW�OHYHO�RQ�DW�OHDVW����SHUFHQW�RI�WKH�PHDVXUHV�LQ�HDFK�GRPDLQ�WR�DYRLG�EHLQJ�SODFHG�RQ�D�FRUUHFWLYH�DFWLRQ�SODQ�
Incorporation of the Physician Quality Reporting System into the Shared Savings Program:�7KH�$IIRUGDEOH�&DUH�$FW�DOORZV�&06�WR�LQFRUSRUDWH�WKH�3K\VLFLDQ�4XDOLW\�5HSRUWLQJ�6\VWHP�UHSRUWLQJ�UHTXLUHPHQWV�DQG�LQFHQWLYH�SD\PHQWV�LQWR�WKH�6KDUHG�6DYLQJV�3URJUDP��$&2�SDUWLFLSDQWV�WKDW�LQFOXGH�SURYLGHUV�VXSSOLHUV�ZKR�DUH�DOVR�HOLJLEOH�SURIHVVLRQDOV�IRU�SXUSRVHV�RI�WKH�3K\VLFLDQ�4XDOLW\�5HSRUWLQJ�6\VWHP�ZLOO�HDUQ�WKH�3K\VLFLDQ�4XDOLW\�5HSRUWLQJ�6\VWHP�LQFHQWLYH�DV�D�JURXS�SUDFWLFH�XQGHU�WKH�6KDUHG�6DYLQJV�3URJUDP��E\�UHSRUWLQJ�UHTXLUHG�FOLQLFDO�TXDOLW\�PHDVXUHV�WKURXJK�WKH�$&2�*URXS�3UDFWLFH�5HSRUWLQJ�2SWLRQ��*352��ZHE�LQWHUIDFH��LQ�HDFK�FDOHQGDU�\HDU�UHSRUWLQJ�SHULRG�WKH�$&2�IXOO\�DQG�FRPSOHWHO\�UHSRUWV�WKH�$&2�*352�PHDVXUHV�
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Improving Quality of Care for Medicare Patients:
Accountable Care Organizations
Official CMS Information forMedicare Fee-For-Service Providers
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