CAHPS for ACOs and PQRS
Overview of the Development and
Implementation of CAHPS for ACOs and PQRS
Sandra Adams, RN, BSN Lauren Fuentes, MPH
July 10-11, 2014
• Overview of the Medicare Shared Savings
Program Quality Measurement and Reporting
• CAHPS for ACO Survey Development and Content
• CAHPS for ACO Survey Administration Timeline
• Overview of Physician Quality Reporting System (PQRS) and 2014 Requirements
• CAHPS for PQRS Implementation
• Public Reporting
• Resources and Help
Agenda
• The Shared Savings Program is an new approach to the delivery of health care aimed at reducing fragmentation, improving population health, and lowering overall growth in expenditures by:
– Promoting accountability for the care of Original Medicare beneficiaries
– Improving coordination of care for services provided under Medicare Parts A and B
– Encouraging investment in infrastructure and redesigned care processes
Medicare Shared Savings Program
Goals
• Quality measures are separated into the following four key domains that serve as the basis for
assessing, benchmarking, rewarding, and improving ACO quality performance:
– Better Care for Individuals
1. Patient/Caregiver Experience 2. Care Coordination/Patient Safety
– Better Health for Populations
3. Preventive Health 4. At-Risk Population
Shared Savings Program Quality Standard Measure Domains
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• The Shared Savings Program Rule required that the patient experience survey for the program be based on the CAHPS® Clinician & Group Survey (CG-CAHPS)
• These survey domains are required:
o Getting Timely Care, Appointments, & Information o How Well Your Providers Communicate
o Patient’s Rating of Provider o Access to Specialists
o Health Promotion and Education o Shared Decision-making
o Health Status & Functional Status
• To identify relevant items within each of these domains, as well as possible new domains, a Technical Expert Panel
(TEP) was convened
• Focus groups were conducted with fee-for-service
Medicare beneficiaries to allow them to share what is important to them when they receive care
CAHPS for ACOs:
Survey Development
Combining input from these sources, a draft survey instrument developed
Cognitive interviews were conducted with beneficiaries to refine item wording and a
field test was conducted in the spring of 2012
We revised the survey based on analyses of the field test data
The first national survey administration with all ACOs occurred January – April 2013
CAHPS for ACOs:
Survey Development (cont.)
Number Summary Survey Measure (SSM) Source
1-7 Getting Timely Care, Appointments, & Information
How Well Your Providers Communicate
Patient’s Rating of Provider
Access to Specialists
Health Promotion and Education
Shared Decision-making
Health Status & Functional Status*
CG CAHPS Core,
CG CAHPS Supplemental, New Items
These SSMs are part of the ACO quality
performance score, there are 14 possible points for CAHPS
8 Courteous & Helpful Office Staff CG CAHPS Core- Not part of the ACO quality
performance score 9-12** Care Coordination
Between Visit Communication
Educating Patient about Medication Adherence
Stewardship of Patient Resources
CAHPS Supplemental and new questions – Not part of the ACO quality performance score
Summary Survey Measures in CAHPS for ACOs
*Remains pay for reporting in 2014
**There are 2 versions of the survey for 2014, these summary survey measures are optional
• Survey asks respondents to describe their experiences with a named “focal provider”
• The focal provider provides the most primary care services to the beneficiary based on the number of visits
• The focal provider can be a primary care provider or a specialist that provided primary care services
• Other survey questions ask about the health care team and practice staff
CAHPS Survey Content:
Focal Provider
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• Administration of the 2013 survey occurred January 2014- March 2014
• Survey results will be available this summer and are reported with each ACO’s quality report
• ACOs receive a detailed CAHPS specific report in the fall of 2014
• CAHPS data may be reported on Physician Compare in late 2014 or early 2015
• ACOs choose survey vendor from a list of CMS-certified vendors by September 22, 2014 for the survey administration period that begins in November 2014
CAHPS for ACOs Key Dates for 2014
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• ACOs receive an annual quality performance report with their scores on all 33 quality
measures for 4 ACO quality domains
• ACOs receive a comprehensive CAHPS report in the fall that details ACO performance on each summary survey measure
Quality Performance
Feedback to ACOs
Domain
Total Individual Measures
Total Measures for Scoring Purposes
Total Potential Points per
Domain
Domain weight (percent)
Patient/Caregiver Experience
7 7 measures* 14 25
Care Coordination/
Patient Safety
6 6 measures; the EHR measure double-weighted (4 points)
14 25
Preventive Health 8 8 measures 16 25
At-Risk Population 12 7 measures, including 5-
component diabetes composite measure and 2-component CAD composite measure
14 25
Total 33 23 58 100
Quality Scoring:
Total Possible Points by Domain
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* The functional status measure remains pay-for-reporting for the entire agreement period
• Complete and accurate reporting for the first reporting period/first performance year qualifies the ACO to share in the maximum
available sharing rate for payment
• In future program years:
– Must meet minimum attainment level to receive points for measures
– Shared savings payments linked to quality performance based on a sliding scale
– High-performing ACOs receive higher sharing rate for payment
Pay for Performance Phase-In
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Year 1 Year 2 Year 3
Pay for Performance Measures 0 25 32
Pay for Reporting Measures 33 8 1
Total 33 33 33
• PQRS is a reporting program that uses incentive payments and payment adjustments to promote reporting of quality
information
– Incentive payments continue through the 2014 program year – Payment adjustments begin in 2015 and are based on prior
years’ reporting
• Eligible professionals (EPs) can report individually or as a group practice participating in the group practice reporting option (GPRO)
• The creation of the PQRS program was mandated by federal legislation, but participation is voluntary for EPs
Physician Quality Reporting System
(PQRS) Overview
The following professionals are eligible to participate in PQRS in 2014:
Beginning in 2014, professionals who reassign benefits to Critical Access Hospitals (CAHs) that bill professional services at a facility level, such as CAH Method II billing, can now participate (in all reporting methods except for claims-based)
2014 Eligible Professionals
• 2014 is the last year that EPs can earn payment incentives
• EPs who satisfactorily report quality-measures data for services provided in 2014 are:
– Eligible to earn an incentive payment of 0.5 percent of the EP's total Medicare Part B Physician Fee Schedule (PFS) covered services provided in 2014
• 2014 is also the performance year for the 2016 PQRS payment adjustment
– Payment adjustment in 2016 is -2.0 percent of EP’s Part B covered professional services under Medicare PFS
Incentives and Payment Adjustments in
2014
• Most PQRS reporting options require an EP or group practice to report 9 measures covering at least 3 of 6 NQS domains:
– Patient Safety
– Person and Caregiver-Centered Experience and Outcomes – Communication and Care Coordination
– Effective Clinical Care
– Community/Population Health – Efficiency and Cost Reduction
• Same domains for EHR Incentive Programs Clinical Quality Measures
National Quality Strategy (NQS)
Domains
To participate in the 2014 PQRS program, individual EPs may choose to report quality information to CMS through one of the following methods:
1. Medicare Part B claims 2. Qualified registry
3. Qualified Clinical Data Registry (QCDR)
4. Direct electronic health record (EHR) using certified EHR technology (CEHRT)
5. CEHRT via data submission vendor
PQRS Reporting: Individuals
To participate in the 2014 PQRS program, group practices may choose to report quality information to CMS through one of the following methods:
1. Qualified registry
2. Direct EHR using CEHRT (Certified EHR Technology) 3. CEHRT via data submission vendor
4. Web interface (for groups of 25+ only)
5. CAHPS CMS-certified survey vendor (for groups of 25+ only, supplement to other methods)
A group practice under 2014 PQRS consists of a physician group
practice, as defined by a single Tax Identification Number (TIN), with 2 or more individual EPs, as identified by individual National Provider Identifier or NPI, who have reassigned their billing rights to the TIN.
PQRS Reporting: Groups
• Group practices with 100+ EPs reporting GPRO web interface must:
– Report all 12 CAHPS for PQRS survey summary modules; AND
– Complete all 22 PQRS GPRO web interface quality measures
• CMS to bear cost of administering this required CAHPS for PQRS survey
PY 2014 CAHPS for PQRS Requirements
• Group practices with 25+ EPs can:
– Report all 12 CAHPS for PQRS survey summary modules; AND
– report at least 6 measures covering at least 2 of the NQS domains using a qualified registry, a CEHRT direct product, or a CEHRT data submission vendor; OR all 22 PQRS GPRO web interface measures
• CMS to bear cost of this optional CAHPS for PQRS survey
PY 2014 CAHPS for PQRS Requirements
Number Summary Survey Measure (SSM) Source
1-7 Getting Timely Care, Appointments, & Information
How Well Your Providers Communicate
Patient’s Rating of Provider
Access to Specialists
Health Promotion and Education
Shared Decision-making
Health Status & Functional Status
CG CAHPS Core,
CG CAHPS Supplemental, New Items
8 Courteous & Helpful Office Staff CG CAHPS
9-12 Care Coordination
Between Visit Communication
Educating Patient about Medication Adherence
Stewardship of Patient Resources
CAHPS Supplemental and new questions
Summary Survey Measures in
CAHPS for PQRS
• PY 2013 CAHPS
– Implemented for group practices with 100+ EPs reporting through the GPRO web interface
– Same survey content as CAHPS for ACOs – Data collected April – July 2014
– Detailed results will be shared with groups in early 2015
CAHPS for PQRS Implementation
• PY 2014 CAHPS
– Groups have until 9/30/14 to register and make
reporting selection online at https://portal.cms.gov – Option to include 2014 CAHPS data in 2016 physician
value modifier calculation
– Same survey content as CAHPS for ACOs
– CMS aims to collect CAHPS data in early 2015
– CMS aims to provide results to groups in the fall of 2015
CAHPS for PQRS Implementation
• Medicare beneficiaries only
• Assigned to provider who provides the most primary care services to the beneficiary based on the number of visits
• Meet minimum number of beneficiaries
– Groups with 100+ EPs: 416 – Groups with 25-99 EPs: 255
2014 Sampling Considerations
PQRS
• CMS may publically report 2014 CAHPS data for group practices of 100+ EPs reporting through PQRS GPRO web interface in 2015
• CMS may publically report 2014 CAHPS data for groups of 25 to 99 EPs in 2015
ACOs
• Display of Quality Data for ACOs began with the 2012
reporting period for a subset of quality measures reported via the GPRO web interface
• ACO CAHPS data may be displayed on Physician Compare for the 2013 reporting period, displayed in late 2014 / early 2015
Public Reporting on Physician Compare
Materials available at CMS.gov/PQRS include:
• PQRS Overview Factsheet
• PQRS: What’s New for 2014 Factsheet
• Made Simple Guides on Educational Resources webpage
• 2014 PQRS Implementation Guide
CMS Resources
• ACO quality website:
http://cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/sharedsavingsprogram/Quality_Measures_Standards.html
• ACO CAHPS website:
http://acocahps.cms.gov/Content/Default.aspx
• PQRS CAHPS website:
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/PQRS/CMS-Certified-Survey-Vendor.html
CMS Resources
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• For questions or assistance with PQRS reporting contact the QualityNet Help Desk, the help desk is available Monday–
Friday; 7:00 AM–7:00 PM CST to assist with:
– General CMS PQRS information – Portal password issues
– Feedback report availability and access – PQRI-IACS registration questions
– PQRI-IACS login issues
Phone: 1-866-288-8912 TTY: 1-877-715-6222
Email: [email protected]
• CAHPS for PQRS Technical Assistance is available by emailing [email protected].