The “Quality Performance Standards” section of the Medicare Shared Savings Program (MSSP) outlines the requirements that Accountable Care Organizations (ACOs) must meet to qualify for shared savings. These standards are designed to ensure that ACOs deliver high-quality care to their beneficiaries while also achieving cost savings. Here are the key components of the Quality Performance Standards:

Quality Performance Standard

• Definition: ACOs must achieve a minimum level of quality performance to be eligible for shared savings. This ensures that cost reductions are not achieved at the expense of care quality.

Health Equity Adjusted Quality Performance Score

• Purpose: Adjusts the quality performance score based on the proportion of underserved populations served by the ACO.

• Calculation: Factors in elements such as the ACO’s ability to improve health outcomes for disadvantaged groups, providing an incentive to focus on equity in healthcare delivery.

Quality Measures

• Categories: The quality measures are divided into several categories, including:

• Patient/Caregiver Experience: Assesses satisfaction and engagement through surveys.

• Care Coordination/Patient Safety: Includes metrics such as readmission rates and medication management.

• Preventive Health: Covers preventive services like vaccinations and screenings.

• At-Risk Populations: Focuses on the management of chronic conditions like diabetes and hypertension.

Reporting Requirements

• Data Submission: ACOs must submit quality data through CMS-approved mechanisms, such as the Quality Payment Program (QPP) portal.

• Timeliness: ACOs must adhere to specified deadlines for data submission to ensure timely evaluation.

Performance Benchmarks

• Benchmark Setting: Benchmarks for each quality measure are set based on national performance data. These benchmarks provide a standard against which ACOs’ performance is measured.

Quality Improvement

• Year-over-Year Improvement: ACOs must demonstrate improvement in quality measures over time, highlighting a commitment to continuous quality enhancement.

Data Submission Deadlines

• Adherence: ACOs must comply with CMS-specified deadlines for submitting quality data. Timely submission is crucial for the evaluation of performance and eligibility for shared savings.

Patient-Centered Care

• Focus Areas: Measures include patient engagement, shared decision-making, and personalized care planning, ensuring that patient needs and preferences are central to care delivery.

Use of Electronic Health Records (EHRs)

• Requirement: ACOs are required to use certified EHR technology to capture and report quality data, facilitating accurate and efficient data management.

Compliance and Audits

• Verification: ACOs may be subject to audits to verify the accuracy and completeness of submitted quality data, ensuring the integrity of the quality assessment process.

Alternative Quality Performance Standard

• Sliding Scale: For ACOs that do not meet the minimum quality performance standard, an alternative sliding scale approach is used to determine shared savings. This allows ACOs to still benefit from shared savings based on partial achievement of quality targets.

These components collectively ensure that ACOs in the MSSP focus on delivering high-quality, patient-centered care while also managing costs effectively. The emphasis on health equity, continuous improvement, and rigorous data reporting underpins the program’s commitment to enhancing healthcare outcomes for all beneficiaries.