2015 ACO Quality Measures
Content
2015
33 Measures of Careof Care
Patient/Care Giver Experience
CAHPS Survey Late 2015-Early 2016
DESCRIPTIONSPECIAL INSTRUCTIONS
Getting timely care, appointments and information (ACO-1)
1
2 How well your doctor communicates (ACO-2)
3 Rating of your doctor (ACO-3)
Access to specialists (ACO-4)
4
5
Health promotion and preventive
Education (ACO-5)
6
Health status and functional status (ACO– 7)
7
8 Stewardship of Patient Resources (ACO -34)
Shared decision making (ACO-6)
Items 1– 8 are experience of care measures that
will be done by Medicare directly with beneficiaries.
Providers are responsible for beneficiary satisfaction;
however, office documentation is not required.
2015
33 Measures of Careof Care
Aim 1: Better Care for Individuals
Care Coordination/Patient Safety
DESCRIPTIONSPECIAL INSTRUCTIONS
Risk standardized all condition readmission (ACO-8)
99
Ambulatory sensitive conditions admissions: COPD or asthma in older adults (ACO-9)
10
11
Datameasures
source for
items 9-16 come from Claims Data with #16 also coming from Admin
Skilled nursing facility 30-day all-cause readmission
(ACO-35)
12
Ambulatory sensitive conditions admissions: heart failure (ACO-10)
All-cause unplanned admissions for patients with diabetes (ACO-36)
13
All-cause unplanned admissions for patients with heart failure (ACO-37)
14
155
Percent of primary
16 care physicians who successfully meet Meaningful Use requirements (ACO-11)
All-cause unplanned admissions for patients with multiple chronic conditions (ACO-38)
17
Documentation of current medications in the medical record (ACO-39) and (CARE-3)
Items 17 & 18 are safety measures and come from GPRO data collection tools
Falls: Screening for future fall risk (ACO-13) and (CARE-2)
18
2015
33 Measures of Careof Care
Aim 2: Better Health for Populations
Preventative Health
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
19
Breast cancer screening
(ACO-20) and (PREV-5)
DESCRIPTION
SPECIAL INSTRUCTIONS
Exclusions:
Bilateral mastectomy or there is evidence of two unilateral mastectomies
Women ages 50-74;
Can be self-reported
Mammography ordered
Report in chart
Communication with patient
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Inclusions:
20
Exclusions:
Colorectal cancer screening
Fecal occult blood test during measurement period
Medical reason: colectomy
(ACO-19) and (PREV-6)
Flex Sig procedure during time period
Colonoscopy during measurement period or nine years prior to the measurement period
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions
influenza immunization
Preventive care and screening: influenza immunization everyReceived
year
Self-reported
(ACO-14) and (PREV-7)
Received the flu shot
Timeframe: Oct 1 – March 31
21
SPECIAL INSTRUCTIONS
Exceptions:
Medical reason with documentation
2015
33 Measures of Careof Care
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Inclusion
22
Pneumonia vaccinations
(ACO-115) and (PREV-8)
65 yrs. and older
Received pneumonia vaccine
Self-reported
Received the pneumonia shot
DESCRIPTION
23
Exclusions:
Medical reason with documentation
REQUIRED DOCUMENTATION
Normal BMI, no follow-up
Follow-up for <23, nutrition intervention
Follow-up for >30, exercise, diet, counseling
Age 18 and older
Body Mass Index
(ACO-16) and (PREV-9)
DESCRIPTION
SPECIAL INSTRUCTIONS
Exclusions:
Pregnant
Exceptions: with documentation
Medical reason
Patient reason
REQUIRED DOCUMENTATION
Inclusions:
SPECIAL INSTRUCTIONS
Exclusions:
Limited life expectancy or other medical reason
Tobacco screening and cessation intervention
Screened for use at least once in 24 months and received cessation counseling
(ACO-17) and (PREV-10)
24
Age 18 and older seen for two visits or at least one preventative visit
2015
33 Measures of Careof Care
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
Screening for depression and follow- up plan every 12 months
(ACO-18) and (PREV-12)
25
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
26
Screening for high blood pressure
(ACO-21) and (PREV-11)
SPECIAL INSTRUCTIONS
Exclusions:
1. Patient refuses
2. Patient in urgent or emergent situation
3. Referred with dx of depression
4. In treatment for depression
5. Severe mental or physical incapacity
Limited life expectancy or other medical reason
SPECIAL INSTRUCTIONS
Exclusions:
Diagnosis of hypertension
18 yrs of age and screened for high blood pressure and
Medical reason: in urgent or emergent medical situation
Recommended follow-up plan based on current BP
2015
33 Measures of Careof Care
Aim 2: Preventative Health
Clinical Care for At-Risk Population
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
Medical reason for not prescribing ACE inhibitor or ARB therapy
Patient reason
Coronary Artery Disease: ACE or ARB Therapy 18 and older; seen in last 12 months and prior
LVEF <40%
System reason
(ACO-33) and (CAD-7) Composite score all or nothing
Inclusions:
27
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
SPECIAL INSTRUCTIONS
Exclusions:
Medical reason such as steroid-induced diabetes, gestational diabetes
Diabetes: HbA1c Poor Control
(ACO-27) and (DM-2) Composite score all or nothing
28
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
SPECIAL INSTRUCTIONS
Exclusions:
None
Diabetes: Eye Exam
18-75 yrs of age with diabetes and visit during measurement period
(ACO-41) and (DM-7)) Composite score all or nothing
29
2015
33 Measures of Careof Care
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
Documentation of medical reason i.e., low BP, IV inotropic agent, allergy, asthma, allergy or other medical reason:
Patient reason
Heart Failure: Beta-blocker therapy 18-yrs
for LVSD
and older with HF and
prior reason
LVEF <40% taking beta-blocker therapy
System
Inclusions:
(ACO-31) and (HF-6)
30
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
ESRD, dialysis or renal transplant
Pregnancy
Controlling High Blood Pressure
18-85 yrs of age with diagnosis HTN and blood pressure adequately controlled
(ACO-28) and (HTN-2)
BP <140/90
Documentation of follow-up, referral, counseling etc.
Inclusions:
31
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
Ischemic Vascular Disease: Use of Aspirin or another Antithrombitic (Incl. post MI, CABG, PTCA) or active diagnosis of IVD
(ACO-30) and (IVD-2)
18 yrs and older
32
Exclusions:
None
Aspirin or other antithrombotic therapy use
Non-aspirin use and recommendations
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
Patients who:
Have died
Depression remission at 12 months
18-yrs and older with major depression or dysthymia and initial PHQ-9 score >9
Received hospice services
(ACO-40) and (MH-1)
Permanent nursing home resident
Applies to new and existing diagnosis of depression
Bipolar disorder
Personality disorder
Inclusions:
33
SPECIAL INSTRUCTIONS
33 Measures of Careof Care
Patient/Care Giver Experience
CAHPS Survey Late 2015-Early 2016
DESCRIPTIONSPECIAL INSTRUCTIONS
Getting timely care, appointments and information (ACO-1)
1
2 How well your doctor communicates (ACO-2)
3 Rating of your doctor (ACO-3)
Access to specialists (ACO-4)
4
5
Health promotion and preventive
Education (ACO-5)
6
Health status and functional status (ACO– 7)
7
8 Stewardship of Patient Resources (ACO -34)
Shared decision making (ACO-6)
Items 1– 8 are experience of care measures that
will be done by Medicare directly with beneficiaries.
Providers are responsible for beneficiary satisfaction;
however, office documentation is not required.
2015
33 Measures of Careof Care
Aim 1: Better Care for Individuals
Care Coordination/Patient Safety
DESCRIPTIONSPECIAL INSTRUCTIONS
Risk standardized all condition readmission (ACO-8)
99
Ambulatory sensitive conditions admissions: COPD or asthma in older adults (ACO-9)
10
11
Datameasures
source for
items 9-16 come from Claims Data with #16 also coming from Admin
Skilled nursing facility 30-day all-cause readmission
(ACO-35)
12
Ambulatory sensitive conditions admissions: heart failure (ACO-10)
All-cause unplanned admissions for patients with diabetes (ACO-36)
13
All-cause unplanned admissions for patients with heart failure (ACO-37)
14
155
Percent of primary
16 care physicians who successfully meet Meaningful Use requirements (ACO-11)
All-cause unplanned admissions for patients with multiple chronic conditions (ACO-38)
17
Documentation of current medications in the medical record (ACO-39) and (CARE-3)
Items 17 & 18 are safety measures and come from GPRO data collection tools
Falls: Screening for future fall risk (ACO-13) and (CARE-2)
18
2015
33 Measures of Careof Care
Aim 2: Better Health for Populations
Preventative Health
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
19
Breast cancer screening
(ACO-20) and (PREV-5)
DESCRIPTION
SPECIAL INSTRUCTIONS
Exclusions:
Bilateral mastectomy or there is evidence of two unilateral mastectomies
Women ages 50-74;
Can be self-reported
Mammography ordered
Report in chart
Communication with patient
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Inclusions:
20
Exclusions:
Colorectal cancer screening
Fecal occult blood test during measurement period
Medical reason: colectomy
(ACO-19) and (PREV-6)
Flex Sig procedure during time period
Colonoscopy during measurement period or nine years prior to the measurement period
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions
influenza immunization
Preventive care and screening: influenza immunization everyReceived
year
Self-reported
(ACO-14) and (PREV-7)
Received the flu shot
Timeframe: Oct 1 – March 31
21
SPECIAL INSTRUCTIONS
Exceptions:
Medical reason with documentation
2015
33 Measures of Careof Care
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Inclusion
22
Pneumonia vaccinations
(ACO-115) and (PREV-8)
65 yrs. and older
Received pneumonia vaccine
Self-reported
Received the pneumonia shot
DESCRIPTION
23
Exclusions:
Medical reason with documentation
REQUIRED DOCUMENTATION
Normal BMI, no follow-up
Follow-up for <23, nutrition intervention
Follow-up for >30, exercise, diet, counseling
Age 18 and older
Body Mass Index
(ACO-16) and (PREV-9)
DESCRIPTION
SPECIAL INSTRUCTIONS
Exclusions:
Pregnant
Exceptions: with documentation
Medical reason
Patient reason
REQUIRED DOCUMENTATION
Inclusions:
SPECIAL INSTRUCTIONS
Exclusions:
Limited life expectancy or other medical reason
Tobacco screening and cessation intervention
Screened for use at least once in 24 months and received cessation counseling
(ACO-17) and (PREV-10)
24
Age 18 and older seen for two visits or at least one preventative visit
2015
33 Measures of Careof Care
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
Screening for depression and follow- up plan every 12 months
(ACO-18) and (PREV-12)
25
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
26
Screening for high blood pressure
(ACO-21) and (PREV-11)
SPECIAL INSTRUCTIONS
Exclusions:
1. Patient refuses
2. Patient in urgent or emergent situation
3. Referred with dx of depression
4. In treatment for depression
5. Severe mental or physical incapacity
Limited life expectancy or other medical reason
SPECIAL INSTRUCTIONS
Exclusions:
Diagnosis of hypertension
18 yrs of age and screened for high blood pressure and
Medical reason: in urgent or emergent medical situation
Recommended follow-up plan based on current BP
2015
33 Measures of Careof Care
Aim 2: Preventative Health
Clinical Care for At-Risk Population
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
Medical reason for not prescribing ACE inhibitor or ARB therapy
Patient reason
Coronary Artery Disease: ACE or ARB Therapy 18 and older; seen in last 12 months and prior
LVEF <40%
System reason
(ACO-33) and (CAD-7) Composite score all or nothing
Inclusions:
27
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
SPECIAL INSTRUCTIONS
Exclusions:
Medical reason such as steroid-induced diabetes, gestational diabetes
Diabetes: HbA1c Poor Control
(ACO-27) and (DM-2) Composite score all or nothing
28
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
SPECIAL INSTRUCTIONS
Exclusions:
None
Diabetes: Eye Exam
18-75 yrs of age with diabetes and visit during measurement period
(ACO-41) and (DM-7)) Composite score all or nothing
29
2015
33 Measures of Careof Care
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
Documentation of medical reason i.e., low BP, IV inotropic agent, allergy, asthma, allergy or other medical reason:
Patient reason
Heart Failure: Beta-blocker therapy 18-yrs
for LVSD
and older with HF and
prior reason
LVEF <40% taking beta-blocker therapy
System
Inclusions:
(ACO-31) and (HF-6)
30
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
ESRD, dialysis or renal transplant
Pregnancy
Controlling High Blood Pressure
18-85 yrs of age with diagnosis HTN and blood pressure adequately controlled
(ACO-28) and (HTN-2)
BP <140/90
Documentation of follow-up, referral, counseling etc.
Inclusions:
31
DESCRIPTION
REQUIRED DOCUMENTATION
Inclusions:
Ischemic Vascular Disease: Use of Aspirin or another Antithrombitic (Incl. post MI, CABG, PTCA) or active diagnosis of IVD
(ACO-30) and (IVD-2)
18 yrs and older
32
Exclusions:
None
Aspirin or other antithrombotic therapy use
Non-aspirin use and recommendations
DESCRIPTION
REQUIRED DOCUMENTATION
SPECIAL INSTRUCTIONS
Exclusions:
Patients who:
Have died
Depression remission at 12 months
18-yrs and older with major depression or dysthymia and initial PHQ-9 score >9
Received hospice services
(ACO-40) and (MH-1)
Permanent nursing home resident
Applies to new and existing diagnosis of depression
Bipolar disorder
Personality disorder
Inclusions:
33
SPECIAL INSTRUCTIONS
