ACO ID: D0155
ACO Type: Standard
Table 1. Summary Information | |||||||||||
| Measure | Measure Name | Measure Score | Points Earned | Points Possible | Total Points | Initial Quality Score (0-100%)1 | CI/SEP Gateway Multiplier2,3 | DR Adjustment (Percentage Points) | Total Quality Score (0-100%) | Quality Withhold Earned Back (0-2% of the financial benchmark) | HPP Bonus2,4 |
| ACR | Risk-Standardized, All-Condition Readmission (a lower [↓] score indicates better performance) | 15.38 | 9.000 | 10 | 34.375 | 85.938% | 1.0 | 9.79 | 95.728% | 1.915% | No |
| UAMCC | Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (a lower [↓] score indicates better performance) | 34.84 | 8.000 | 10 | |||||||
| TFU | Timely Follow-Up After Acute Exacerbations of Chronic Conditions (a higher [↑] score indicates better performance) | 77.25 | 9.000 | 10 | |||||||
| CAHPS5 | Consumer Assessment of Healthcare Research and Quality (a higher [↑] score indicates better performance) | 0.838 | 8.375 | 10 |
How to Perform the Calculations
Footnotes:
1. The Initial Quality Score is calculated by dividing the Total Points Earned (sum of “”Points Earned”” column) by the Total Points Possible (sum of “”Points Possible”” column). If your ACO was exempt from the CAHPS Survey submission requirement or had points assigned for fewer than 50%, or four out of the eight SSMs, your ACO will not receive a CAHPS Composite Score and the Total Points Possible will be reduced by 10. Therefore, the Total Points Possible will be 30 rather than 40.
2. The CI/SEP Gateway Multiplier and the HPP Bonus apply to all REACH ACOs in PY 2024.
3. Please see Table 2a for more detailed information regarding the CI/SEP multiplier determination for your ACO.
4. Please see Table 2b for more detailed information regarding the determination of whether your ACO met the HPP Bonus criteria.
5. The CAHPS measure score shown in Table 1 is equal to the CAHPS Composite Score as calculated in Table 4. This value is multiplied by 10 to determine the number of points earned for CAHPS out of 10 points possible in the calculation of the Initial Quality Score. Please note that the CAHPS results in Table 1 are rounded for display. However, the calculation of your ACO’s Total Points Earned is based on the unrounded CAHPS Composite Score and points earned. See Tables 4 and 5 for additional information on how CMMI determined the points your ACO earned for CAHPS.
ACO ID: D0155
ACO Type: Standard
Table 1. Summary Information | |||||||||||
| Measure | Measure Name | Measure Score | Points Earned | Points Possible | Total Points | Initial Quality Score (0-100%)1 | CI/SEP Gateway Multiplier2,3 | HEDR Adjustment (Percentage Points) | Total Quality Score (0-100%) | Quality Withhold Earned Back (0-2% of the financial benchmark) | HPP Bonus2,4 |
| ACR | Risk-Standardized, All-Condition Readmission (a lower [↓] score indicates better performance) | 15.73 | 0.000 | 10 | 25.344 | 63.359% | 0.5 | 7.20 | 38.880% | 0.778% | No |
| UAMCC | Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (a lower [↓] score indicates better performance) | 34.55 | 8.250 | 10 | |||||||
| TFU | Timely Follow-Up After Acute Exacerbations of Chronic Conditions (a higher [↑] score indicates better performance) | 71.43 | 8.500 | 10 | |||||||
| CAHPS | Consumer Assessment of Healthcare Research and Quality5 (a higher [↑] score indicates better performance) | 0.86 | 8.594 | 10 |
How to Perform the Calculations
Footnotes
1. The Initial Quality Score is calculated by dividing the Total Points Earned (sum of “”Points Earned”” column) by the Total Points Possible (sum of “”Points Possible”” column). If your ACO was exempt from the CAHPS Survey submission requirement or had points assigned for fewer than 50%, or 4 out of the 8 SSMs, your ACO will not receive a CAHPS Composite Score and the Total Points Possible will be reduced by 10. Therefore, the Total Points Possible will be 30 rather than 40.
2. The CI/SEP Gateway Multiplier and the HPP Bonus only apply to REACH ACOs that began participating in ACO REACH prior to PY 2023. ACOs that did not begin participating in ACO REACH until PY 2023 will receive “”N/A”” for these values.
3. Please see Table 2a for more detailed information regarding the CI/SEP multiplier determination for your ACO (applicable only to REACH ACOs that began participating in ACO REACH prior to PY 2023).
4. Please see Table 2c for more detailed information regarding the determination of whether your ACO met the HPP Bonus criteria (applicable only to REACH ACOs that began participating in ACO REACH prior to PY 2023).
5. See Tables 4 and 5 for detailed information on how CMMI determined the points your ACO earned for CAHPS.
DCE ID: D0155
DCE Type: Standard
| Table 1. Summary Information | ||||||
| Measure | Official Measure Set – Measure Name | Your DCE’s Quality Measure Score | P4P Percentile Rank1 | P4P Component Quality Score2 | P4R Component Quality Scores3,4 | Total Quality Score |
| ACR | Risk-Standardized, All-Condition Readmission (a lower (↓) score indicates better performance) | 15.11 | 65.6 | 100.00% | 100.00% | 100.00% |
| UAMCC | Risk-Standardized, All-Cause Unplanned Admissions for Patients with Multiple Chronic Conditions (per 100 person-years) (a lower (↓) score indicates better performance) | 28.93 | 87.6 | |||
| Timely Follow-Up | Timely Follow-Up After Acute Exacerbations of Chronic Conditions (a higher (↑) score indicates better performance) | 77.88 | N/A | N/A | ||
| CAHPS | Consumer Assessment of Healthcare Research and Quality (a higher (↑) score indicates better performance) | N/A | N/A | N/A | 100.00% |
The information provided below is for informational purposes only.
P4P Component Quality Score:
P4R Component Quality Score:
TOTAL QUALITY SCORE:
[(xx% * 1/5)ACR/UAMCC performance + (100% * 2/5)ACR/UAMCC/TFU reporting + (xx% * 2/5)]CAHPS administration
Footnotes:
1. In PY 2022, DCEs must meet the 30th percentile threshold on at least one of two claims-based measures (ACR or UAMCC) to receive the full 1% of the Quality Withhold tied to performance (P4P). A sliding scale is applied to DCEs that do not meet the 30th percentile threshold. Please refer to the PY 2022 Quality Measurement Methodology (QMMR) document for more details.
2. DCEs can earn up to 100% of the 1/5 of the Quality Withhold percentage tied to P4P.
3. In PY 2022, 4/5 of the 5% Quality Withhold (i.e., 4% of the financial benchmark) is tied to reporting (P4R). The 4/5 will be comprised of 2/5 connected to the claims-based quality measures and 2/5 connected to the CAHPS survey in PY 2022. See note 4 below.
4. DCEs will earn 100% of the 2/5 related to claims-based quality measure reporting (no action required by DCEs). DCEs may earn 100% of the 2/5 connected to CAHPS by authorizing a CMS-approved vendor to administer the CAHPS survey in PY 2022.
