What’s YOUR Medicare Quality Score for 2016?

Submitted by Barbara Fenton, MD, Medical Director of Augusta Care Partners

The ACP Quality Committee is excited to share with you your official 2016 Medicare Shared Savings Program Quality Reporting Results. Each year come mid-March, Augusta Care Partners reports your Quality Measures to CMS, from whom we recently received the FINAL results. Since the ACO reports as a group, ALL the providers in our network receive the same roll-up score, which is also the score that will publicly reported on the Physician Compare website this December.

For 2016, we (that means YOU) received a total score of 98.13%. To provide some context, MSSP-ACOs nationally averaged 94% in 2016, excluding those who are in their first year who receive 100% just for reporting.

How does this affect physician Medicare payments? You may recall that incentives and penalties occur two years after the performance year. This 2016 annual quality reporting satisfies your practice’s Medicare quality performance requirements under PQRS and the Value Modifier Programs, ensuring that you will not receive any automatic downward adjustments to your fee schedule in 2018. As a reminder, the network’s quality reporting for 2017 will continue to satisfy CMS requirements, now in a transition period to the MIPS program.

2016 Quality Results

The grid above is the report as it appears from CMS. Four domains, all weighted equally, are averaged for a total score. Quality improvement points may be awarded if the ACO makes significant improvements. You will note that for 3 domains we scored 100%. Quality improvement points made it possible for us to reach the top in each of these categories.

2016 Quality Results: Metric-Level Detail

TABLE 2 Patient and Caregiver Experience is based on a standardized CAHPS survey controlled entirely by Medicare. It is the one domain where we have not yet improved. Only 3 measures came in under the mean: Timely Care, Access to Specialists, and Shared Decision Making. How Well Providers Communicate and Patient’s Rating of Provider were the only measures scoring above 90%, all others were below.

TABLE 3 Care Coordination & Patient Safety is primarily reported via claims and electronic EMR data. While our heart failure admission rates improved, rates for diabetes worsened. Admissions for COPD and asthma were “held harmless” (performance significantly declined, but remained above the 90th percentile). In addition, all cause unplanned admissions for multiple chronic conditions and readmissions from SNFs within 30 days of discharge did not significantly change.

Performance on the “Percent of PCPs Who Successfully Meet Meaningful Use Requirements” measure increased from 56.90% in 2015 to a whopping 97.26%!

Documentation of Current Medications in the Medical Record was significantly lower this year. This is due to the fact that we were required to include all our offices, and non-prescribing providers such as therapies and counseling.

TABLE 4 Performance in Preventive Health, where scores correlate most closely with annual wellness visit rates, significantly improved in ALL measures. All measures were above the mean but we only scored 90% or better in one – tobacco screening. Dramatic improvements in a number of measures — colon cancer screening 44% to 72%, breast cancer screening 28% to 83%, pneumococcal vaccine 45% to 81%, influenza vaccine 26% to 73%, depression screening 21% to 70% — were at least in part due to our transition to internal reporting and a significant increase in annual wellness visit rates in 2016.

TABLE 5  For the At Risk Population, we scored above the mean and improved in Diabetes Composite, IVD and Aspirin or Other Antithrombotic Use, and Use of ACE/ARB in CAD. We remained below the mean in Heart Failure (declined from 2015, related to use of short acting rather than long acting beta blocker) and Hypertension Control. Although the Depression Remission at 12 Months measure score is 0%, this is a complex, problematic measure required for reporting only.

So What Now?

This year these results led ACP’s Quality Committee to select initiatives aimed at increasing colorectal cancer screening, depression screening, and annual wellness visit rates. While we have little to no influence over what measures CMS chooses for our MSSP-ACO contract, we do have the opportunity to select our own metrics for our contract with Augusta Health: the Hospital Quality & Efficiency Program. Augusta Care Partners and its committee members/leadership are currently working closely together to streamline metrics and select ones that are relevant and impactful. New metrics for that program will be shared at the December 19 Provider Meeting, so please plan to attend.