Measurements
Quality measurements reduced from 65 to 33! Well, that is reduced in half. Got to be a good thing. Yes, it is a good thing. The measures are now categorized into 4 domains, namely:
- Patient/Care Giver experience (7 measures)
- Care Coordination/Patient Safety (6 measures)
- Preventive Health (8 measures)
- At Risk Population (12 measures: 7 measures, including 5 component diabetes composite measure and 2 component CAD composite measures)
Pretty Simple, eh? Each domain is given a weightage percent of 25% each and then reported for each of these measures.) In the next blog, we will take a deeper dive into the measurements. And if you want to go straight into implementation, see how Meta Analytix can help you here: http://www.metaanalytix.com/page.php?page=36
Who is eligible?
The newly added section 1899 of the Social Security Act or SSA provides examples of groups of service providers and suppliers that may form an ACO, including
(i) physicians and other health care practitioners (ACO professionals) in a group practice,
(ii) a network of individual practices,
(iii) a partnership or joint venture arrangement between hospitals and ACO professionals, and
(iv) a hospital employing ACO professionals. ACOs eligible to participate in the MSSP (Medicare Shared Savings Program) will manage and coordinate care for their assigned Medicare fee-for-service beneficiaries.
What are the requirements?
According to the IRS (IRS?? - http://www.irs.gov/pub/irs-drop/n-11-20.pdf), the type of organizations wishing to become ACOs must meet the following criteria.
1) The ACO shall be willing to become accountable for the quality, cost, and overall care of the Medicare fee-for-service beneficiaries assigned to it.
(2) The ACO shall enter into an agreement with the HHS Secretary to participate in the program for not less than a 3-year period (the MSSP( (Medicare Shared Savings Program) agreement period).
(3) The ACO shall have a formal legal structure that would allow the organization to receive and distribute payments for shared savings under § 1899(d)(2) to participating providers of services and suppliers.
(4) The ACO shall include primary care ACO professionals that are sufficient for the number of Medicare fee-for-service beneficiaries assigned to the ACO under § 1899(c). At a minimum, the ACO shall have at least 5,000 such beneficiaries assigned to it under § 1899(c) in order to be eligible to participate in the MSSP.
(5) The ACO shall provide the HHS Secretary with such information regarding ACO professionals participating in the ACO as the Secretary determines necessary to support the assignment of Medicare fee-for-service beneficiaries to an ACO, the implementation of quality and the other reporting requirements under § 1899(b)(3), and the determination of payments for shared savings under § 1899(d)(2).
(6) The ACO shall have in place a leadership and management structure that includes clinical and administrative systems.
(7) The ACO shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.
(8) The ACO shall demonstrate to the HHS Secretary that it meets patient-centeredness criteria specified by the Secretary, such as the use of patient and caregiver assessments or the use of individualized care plans.
That's about it. If you have questions, feel free to call me. If I am on the golf course, I am not answering my phone!
