ACO Shared Savings Program Public Use File 2014-2016
This dataset shows the 2014 to 2016 Shared Savings Program (SSP) Accountable Care Organization (ACO) data Public Use File (PUF), which has been updated to include for each ACO the mean final prospective Centers for Medicare and Medicaid Service’s (CMS) Hierarchical Condition Category (HCC) risk score for the four Medicare enrollment types (End-Stage Renal Disease (ESRD), disabled, aged/dual, aged/non-dual) for each of the benchmark year.
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This dataset addresses the increasing number of requests for SSP ACO data, the Centers for Medicare and Medicaid Services (CMS) has created a standard analytical file that CMS can use to efficiently satisfy these requests. It is the intent of CMS to publish the ACO-level public-use file (PUF) that contains ACO-specific metrics as well as summarized beneficiary and provider information for each performance year of the SSP program.
The risk scores used in this dataset are based on the applicable risk adjustment model for the applicable year and renormalized so that the mean national Fee-For-Services (FFS) risk score equals 1.0. Risk scores for each enrollment type are renormalized to their own populations and thus are not on the same scale and not comparable.
The Shared Savings Program has different tracks that allow ACOs to select an arrangement that makes the most sense for their organization.
About this Dataset
Data Info
Date Created
2015-10-30
Last Modified
2017-11-07
Version
2017-11-07
Update Frequency
Annual
Temporal Coverage
2014-2016
Spatial Coverage
United States
Source
John Snow Labs; Centers for Medicare and Medicaid Services (CMS) and Medicare Shared Savings Program (MSSP);
Source License URL
Source License Requirements
N/A
Source Citation
N/A
Keywords
Medicare Shared Savings Program, ACO Data, ACO Healthcare, Medicare ACO, Healthcare ACO, Shared Savings Program, Medicare Shared Savings Program, Public Use File, ACO, Coordinated Care, Medicare
Other Titles
What is an ACO?, ACO Public Use File 2016, ACO Shared Savings Program PUF 2016, Accountable Care Organization SSP PUF 2016
Data Fields
Name
Description
Type
Constraints
ACO_Year
Coverage year of Medicare Shared Savings Program Performance Accountable Care Organizations (ACO) (2014, 2015 and 2016)
string
-
ACO_Number
Encrypted ACO Identifier. Identifier is consistent across performance years.
string
-
ACO_Name
ACO Doing Business As (DBA) or Legal Business Name (LBN).
string
-
ACO_State
Assigned beneficiary state(s) of residence.
string
-
Start_Date
Agreement start date.
date
-
Total_Assigned_Beneficiaries
Number of assigned beneficiaries, performance year.
integer
level : Ratio
Saving_Rate
Total Benchmark Expenditures Minus Assigned Beneficiary Expenditures as a percent of Total Benchmark Expenditures.
number
-
Min_Saving_Percentage
number
-
Benchmark_Minus_Expenditure
Total Benchmark Expenditures Minus Assigned Beneficiary Expenditures. If positive, represents total savings. If negative, represents total losses.
integer
level : Ratio
General_Save_Loss
(Gross) Generated savings: Total savings (measured as Benchmark Minus Expenditures, from first to last dollar) for ACOs whose savings rate equaled or exceeded their minimum savings rate. This amount does not account for the application of the ACO’s final sharing rate based on quality performance, reduction due to sequestration or repayment of advance payments.
integer
level : Ratio
Earned_Save_Loss
Total earned shared savings: The ACO’s share of savings for ACOs whose savings rate equaled or exceeded their minimum savings rate, and who were eligible for a performance payment because they met the program’s quality performance standard. This amount accounts for the application of the ACO’s final sharing rate based on quality performance (not to exceed 50% under Track 1 or 60% under Track 2), as well as the reduction in performance payment due to sequestration and application of the performance payment limit. This amount does not account for repayment of advance payments.
integer
level : Ratio
Quality_Score
ACOs with 2015 start dates will have a “P4R” (Pay for Reporting) displayed for the Quality Score to reflect that their quality performance is based on complete and accurate reporting.
number
level : Ratio
Updated_Benchmark_Expenditure
Benchmark expenditures are risk-adjusted in the historical benchmark period and performance period to account for changes in the ACO's assigned populations over time.
integer
level : Ratio
History_Benchmark
3-year average historical benchmark, risk adjusted. Historical benchmark expenditures are risk-adjusted by applying risk ratios of the BY3 risk score divided by each year’s risk score to the BY1 and BY2 expenditures.
integer
level : Ratio
Total_Benchmark_Expenditure
Per capita benchmark (UpdatedBnchmk) multiplied by total person-years (N_AB_Year).
integer
level : Ratio
Total_Expenditure
Per capita performance year expenditures (Per_Capita_Exp_TOTAL) multiplied by total person-years (N_AB_Year).
integer
level : Ratio
Advance_Payment_Amount
integer
level : Ratio
Advance_Payment_Recoupment
number
level : Ratio
Quality_Performance_Share
Set at 50 percent for Track 1 ACOs and 60 percent for Track 2 ACOs.
number
level : Ratio
Final_Sharing_Rate
Quality performance sharing rate (QualPerfShare) multiplied by quality score (QualScore). The percentage of savings an ACO shares if the ACO is eligible for shared savings. Will equal zero if ACO failed to meet quality performance standard.
number
level : Ratio
Per_Capita_Exp_All_ESRD_by_Year1
Annualized, truncated, weighted mean total expenditures per ESRD assigned beneficiary person years in benchmark year 1.
integer
level : Ratio
Per_Capita_Exp_All_Disabled_by_Year1
Annualized, truncated, weighted mean total expenditures per DISABLED assigned beneficiary person years in benchmark year 1.
integer
level : Ratio
Per_Capita_Exp_All_AGDU_by_Year1
Annualized, truncated, weighted mean total expenditures per AGED/DUAL assigned beneficiary person years in benchmark year 1.
integer
level : Ratio
Per_Capita_Exp_All_AGND_by_Year1
Annualized, truncated, weighted mean total expenditures per AGED/NON-DUAL assigned beneficiary person years in benchmark year 1.
integer
level : Ratio
Per_Capita_Exp_All_ESRD_by_Year2
Annualized, truncated, weighted mean total expenditures per ESRD assigned beneficiary person years in benchmark year 2.
integer
level : Ratio
Per_Capita_Exp_All_Disabled_by_Year2
Annualized, truncated, weighted mean total expenditures per DISABLED assigned beneficiary person years in benchmark year 2.
integer
level : Ratio
Per_Capita_Exp_All_AGDU_by_Year2
Annualized, truncated, weighted mean total expenditures per AGED/DUAL assigned beneficiary person years in benchmark year 2.
integer
level : Ratio
Per_Capita_Exp_All_AGND_by_Year2
Annualized, truncated, weighted mean total expenditures per AGED/NON-DUAL assigned beneficiary person years in benchmark year 2.
integer
level : Ratio
Per_Capita_Exp_All_ESRD_by_Year3
Annualized, truncated, weighted mean total expenditures per ESRD assigned beneficiary person years in benchmark year 3.
integer
level : Ratio
Per_Capita_Exp_All_Disabled_by_Year3
Annualized, truncated, weighted mean total expenditures per DISABLED assigned beneficiary person years in benchmark year 3.
integer
level : Ratio
Per_Capita_Exp_All_AGDU_by_Year3
Annualized, truncated, weighted mean total expenditures per AGED/DUAL assigned beneficiary person years in benchmark year 3.
integer
level : Ratio
Per_Capita_Exp_All_AGND_by_Year3
Annualized, truncated, weighted mean total expenditures per AGED/NON-DUAL assigned beneficiary person years in benchmark year 3.
integer
level : Ratio
Per_Capita_Exp_All_ESRD_Performance_Year
Annualized, truncated, weighted mean total expenditures per ESRD assigned beneficiary person years in the performance year.
integer
level : Ratio
Per_Capita_Exp_All_Disbled_Performance_Year
AAnnualized, truncated, weighted mean total expenditures per DISABLED assigned beneficiary person years in the performance year.
integer
level : Ratio
Per_Capita_Exp_All_AGDU_Performance_Year
Annualized, truncated, weighted mean total expenditures per AGED/DUAL assigned beneficiary person years in the performance year.
integer
level : Ratio
Per_Capita_Exp_All_AGND_Performance_Year
Annualized, truncated, weighted mean total expenditures per AGED/NON-DUAL assigned beneficiary person years in the performance year.
integer
level : Ratio
Per_Capita_Exp_Total_Performance_Year
Annualized, truncated, weighted mean total expenditures per assigned beneficiary person years in the performance year.
integer
level : Ratio
CMS_HCC_Risk_Score_ESRD_BY1
Final, mean prospective CMS-HCC risk score for ESRD enrollment type in benchmark year 1
number
level : Ratio
CMS_HCC_Risk_Score_Disabled_BY1
Final, mean prospective CMS-HCC risk score for DISABLED enrollment type in benchmark year 1
number
level : Ratio
CMS_HCC_Risk_Score_AGDU_BY1
Final, mean prospective CMS-HCC risk score for AGED/DUAL enrollment type in benchmark year 1
number
level : Ratio
CMS_HCC_Risk_Score_AGND_BY1
Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL enrollment type in benchmark year 1
number
level : Ratio
CMS_HCC_Risk_Score_ESRD_BY2
Final, mean prospective CMS-HCC risk score for ESRD enrollment type in benchmark year 2
number
level : Ratio
CMS_HCC_Risk_Score_DIS_BY2
Final, mean prospective CMS-HCC risk score for DISABLED enrollment type in benchmark year 2
number
level : Ratio
CMS_HCC_Risk_Score_AGDU_BY2
Final, mean prospective CMS-HCC risk score for AGED/DUAL enrollment type in benchmark year 2
number
level : Ratio
CMS_HCC_Risk_Score_AGND_BY2
Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL enrollment type in benchmark year 2
number
level : Ratio
CMS_HCC_Risk_Score_ESRD_BY3
Final, mean prospective CMS-HCC risk score for ESRD enrollment type in benchmark year 3
number
level : Ratio
CMS_HCC_Risk_Score_DIS_BY3
Final, mean prospective CMS-HCC risk score for DISABLED enrollment type in benchmark year 3
number
level : Ratio
CMS_HCC_Risk_Score_AGDU_BY3
Final, mean prospective CMS-HCC risk score for AGED/DUAL enrollment type in benchmark year 3
number
level : Ratio
CMS_HCC_Risk_Score_AGND_BY3
Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL enrollment type in benchmark year 3
number
level : Ratio
CMS_HCC_Risk_Score_ESRD_Performance_Year
Final, mean prospective CMS-HCC risk score for ESRD enrollment type in the performance year
number
level : Ratio
CMS_HCC_Risk_Score_DIS_Performance_Year
Final, mean prospective CMS-HCC risk score for DISABLED enrollment type in the performance year
number
level : Ratio
CMS_HCC_Risk_Score_AGDU_Performance_Year
Final, mean prospective CMS-HCC risk score for AGED/DUAL enrollment type in the performance year
number
level : Ratio
CMS_HCC_Risk_Score_AGND_Performance_Year
Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL enrollment type in the performance year.
number
level : Ratio
ESRD_Person_Years_in_Benchmark_Year3
Number of assigned beneficiaries with ESRD enrollment type in benchmark year 3 adjusted for the total number of months that each beneficiary was classified as ESRD; Number of ESRD person-months divided by 12
number
level : Ratio
Disabled_Person_Years_in_Benchmark_Year3
Number of assigned beneficiaries with DISABLED enrollment type in benchmark year 3 adjusted for the total number of months that each beneficiary was classified as DISABLED; Number of DISABLED person-months divided by 12
number
level : Ratio
Aged_Dual_Person_Years_in_Benchmark_Year3
Number of assigned beneficiaries with AGED/DUAL enrollment type in benchmark year 3 adjusted for the total number of months that each beneficiary was classified as AGED/DUAL; Number of AGED/DUAL person-months divided by 12
number
level : Ratio
Aged_Non_Dual_Person_Years_in_Benchmark_Year3
Number of assigned beneficiaries with AGED/NON-DUAL enrollment type in benchmark year 3 adjusted for the total number of months that each beneficiary was classified as AGED/NON-DUAL; Number of AGED/NON-DUAL person-months divided by 12
number
level : Ratio
Total_Person_Years_in_Performance_Year
Number of assigned beneficiaries in the performance year adjusted downwards for beneficiaries with less than a full 12 months of eligibility ; Number of person-months divided by 12
number
level : Ratio
ESRD_Person_Years_in_Performance_Year
Number of assigned beneficiaries with ESRD enrollment type in the performance year adjusted for the total number of months that each beneficiary was classified as ESRD; Number of ESRD person-months divided by 12
number
level : Ratio
Disabled_Person_Years_in_Performance_Year
Number of assigned beneficiaries with DISABLED enrollment type in the performance year adjusted for the total number of months that each beneficiary was classified as DISABLED; Number of DISABLED person-months divided by 12
number
level : Ratio
AGED_DUAL_Person_Years_in_Performance_Year
Number of assigned beneficiaries with AGED/DUAL enrollment type in the performance year adjusted for the total number of months that each beneficiary was classified as AGED/DUAL; Number of AGED/DUAL person-months divided by 12
number
level : Ratio
AGED_NON_DUAL_Person_Years_in_Performance_Year
Number of assigned beneficiaries with AGED/NON-DUAL enrollment type in the performance year adjusted for the total number of months that each beneficiary was classified as AGED/NON-DUAL; Number of AGED/NON-DUAL person-months divided by 12
number
level : Ratio
Total_Assigned_Beneficiaries_Age_0_To_64
Total number of assigned beneficiaries, age 0-64 in CY2016; age calculated as of 2/1/2016. Based on most current date of birth in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Age_65_To_74
Total number of assigned beneficiaries, age 65-74 in CY2016; age calculated as of 2/1/2016. Based on most current date of birth in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Age_75_To_84
Total number of assigned beneficiaries, age 75-84 in CY2016; age calculated as of 2/1/2016. Based on most current date of birth in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Age_85_Plus
Total number of assigned beneficiaries, age 85+ in CY2016; age calculated as of 2/1/2016. Based on most current date of birth in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Female
Total number of assigned beneficiaries, female (Gender=2) in CY2016. Based on most current gender in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Male
Total number of assigned beneficiaries, male (Gender=1) in CY2016. Based on most current gender in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Race_White
Total number of assigned beneficiaries, Non-Hispanic White (Race=1) in CY2016. Based on most current race in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Race_Black
Total number of assigned beneficiaries, Black (Race=2) in CY2016. Based on most current race in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Race_Asian
Total number of assigned beneficiaries, Asian (Race=4) in CY2016. Based on most current race in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Race_Hisp
Total number of assigned beneficiaries, Hispanic (Race=5) in CY2016. Based on most current race in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Race_Native
Total number of assigned beneficiaries, North American Native (Race=6) in CY2016. Based on most current race in Medicare records.
integer
level : Ratio
Total_Assigned_Beneficiaries_Race_Other
Total number of assigned beneficiaries, Other (Race=0,3,~) in CY2016. Based on most current race in Medicare records.
integer
level : Ratio
Total_Inpatient_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for inpatient services for assigned beneficiaries in the performance year. Includes all hospital provider types including but not limited to short term acute care hospital, long term care hospital, rehabilitation hospital or unit, and psychiatric hospital or unit.
integer
level : Ratio
Short_Term_Care_Hospital_Expenditure
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for acute care inpatient services in a short term acute care (Inpatient Prospective Payment System (IPPS) or Critical Access Hospital (CAH)) setting for assigned beneficiaries in the performance year.
integer
level : Ratio
Long_Term_Care_Hospital_Expenditure
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for inpatient services in a long term care setting for assigned beneficiaries in the performance year.
integer
level : Ratio
Inpatient_Rehabilitation_Facility_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for inpatient services in a rehabilitation facility or unit for assigned beneficiaries in the performance year.
integer
level : Ratio
Inpatient_Psychiatric_Hospital_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for inpatient services in a psychiatric hospital facility or unit for assigned beneficiaries in the performance year.
integer
level : Ratio
Hospice_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for hospice services for assigned beneficiaries in the performance year. Hospice claims are identified by claim type code 50.
integer
level : Ratio
Skilled_Nursing_Facility_or_Unit_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for services in a skilled nursing facility (SNF) setting for assigned beneficiaries in the performance year. SNF claims are identified by claim type codes 20 and 30)
integer
level : Ratio
Other_Inpatient_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for other inpatient services in a short term acute care setting for assigned beneficiaries in the performance year. Inpatient claims are identified by claim type code 60
integer
level : Ratio
Outpatient_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for outpatient services for assigned beneficiaries in the performance year. Includes all outpatient facility types including, but not limited to, hospital outpatient departments, outpatient dialysis facilities,
integer
level : Ratio
Physician_Supplier_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for Part B physician/supplier (Carrier) services for assigned beneficiaries in the performance year. Includes all Part B physician/supplier services including, but not limited to, evaluation and management, procedures, imaging, laboratory and other test, Part B drugs, and ambulance services.
integer
level : Ratio
Ambulance_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for ambulance services for assigned beneficiaries in the performance year. Ambulance services are identified in the Part B physician/supplier (Carrier) claims (claim type codes 71 and 72) by BETOS code O1A
integer
level : Ratio
Home_Health_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for home health agency services for assigned beneficiaries in the performance year. Home health claims are identified by claim type code 10
integer
level : Ratio
Durable_Medical_Equipment_Expenditures
Annualized, truncated, weighted mean expenditures per assigned beneficiary person years for durable medical equipment (DME) for assigned beneficiaries in the performance year. DME claims are identified by claim type codes 81 and 82
integer
level : Ratio
Inpatient_Hospital_Discharges
Total number of inpatient hospital discharges per 1,000 person-years in the performance year. A beneficiary is flagged for having a hospitalization if the beneficiary had at least one inpatient claim during the performance year. Each hospitalization is defined as a set of claims with the same Health Insurance Claim Number (HICNO), same admission date, and same provider number.
number
level : Ratio
Short_Term_Acute_Care_Hospital_Discharges
Total number of short term acute care hospital discharges per 1,000 person-years in the performance year. A beneficiary is flagged for having a hospitalization in a short-term acute-care hospital if the beneficiary had at least one inpatient claim during the performance year.
number
level : Ratio
LTCH_Discharges
Total number of long term care hospital (LTCH) discharges per 1,000 person-years in the performance year. A beneficiary is flagged for having a hospitalization in a long-term hospital if the beneficiary had at least one inpatient claim during the performance year.
number
level : Ratio
IRF_Discharges
Total number of inpatient rehabilitation facility (IRF) discharges per 1,000 person-years in the performance year. A beneficiary is flagged for having a hospitalization in a rehabilitation hospital or unit if the beneficiary had at least one inpatient claim during the performance year.
number
level : Ratio
IPF_Discharges
Total number of inpatient psychiatric facility (IPF) discharges per 1,000 person-years in the performance year. A beneficiary is flagged for having a hospitalization in a psychiatric hospital or unit if the beneficiary had at least one inpatient claim during the performance year.
number
level : Ratio
CHF_Discharges
Total number of discharges for congestive heart failure (CHF) per 1,000 person-years in the performance year. Until 2015 Q4, measure specifications are based on AHRQ Prevention Quality Indicators Technical Specifications—Version 4.5. For 2015 Q4, ICD-10 codes CHF were derived from Measure Information Form (MIF) specifications.
number
level : Ratio
COPD_Asthma_Discharges
Total Integer of discharges for chronic obstructive pulmonary disease (COPD) or asthma per 1,000 person-years in the performance year. Until 2015 Q4, measure specifications are based on AHRQ Prevention Quality Indicators Technical Specifications—Version 4.5. For 2015 Q4, ICD-10 codes for COPD/Asthma were derived from Version 5.0.
number
level : Ratio
Bacterial_Pneumonia_Discharges
Total Integer of discharges for bacterial pneumonia per 1,000 person-years in the performance year. Until 2015 Q4, measure specifications are based on AHRQ Prevention Quality Indicators Technical Specifications—Version 4.5.
number
level : Ratio
Short_Term_Acute_Care_Readmissions
Rate of short-term acute-care hospital readmissions within 30 days of discharge from a short-term acute-care hospital (including critical access hospitals) per 1,000 discharges among eligible beneficiaries assigned to the ACO in the performance year. When identifying an initial admission, all overlapping and contiguous hospital bills submitted to Medicare are considered as single hospital stays if there are no breaks greater than one day.
number
level : Ratio
Post_Discharge_Provider_Visits_30_Day
Rate of provider visits within 30 days of discharge from a short-term acute-care hospital (including critical access hospitals) per 1,000 discharges among eligible beneficiaries assigned to the ACO in the performance year.
number
level : Ratio
Skilled_Nursing_Facility_Discharges
Total number of discharges from a skilled nursing facility per 1,000 person-years in the performance year. Each SNF admission is defined as a set of claims with the same HICNO, same admission date, and same provider number.
number
level : Ratio
Outpatient_ED_Visits
Total number of visits to an outpatient emergency department (ED) per 1,000 person-years in the performance year. An Emergency Department Visit (EDV) is defined using both Inpatient & Outpatient claims and using the Revenue Center Code field on the claims.
number
level : Ratio
Inpatient_ED_Visits
Total number of visits to an emergency department (ED) that result in an inpatient stay per 1,000 person-years in the performance year. Emergency Department Visits that Lead to Hospitalizations is identified in the hospital inpatient claims with revenue center code values 0450-0459 and 0981
number
level : Ratio
CT_Events
Total number of computed tomography (CT) events per 1,000 person-years in the performance year. CT imaging events are defined based on BETOS codes I2A (advanced imaging-CAT: head) and I2B (advanced imaging-CAT: other)
number
level : Ratio
MRI_Events
Total number of magnetic resonance imaging (MRI) events per 1,000 person-years in the performance year. MRI imaging events are defined based on BETOS codes I2C (advanced imaging-MRI: brain) and I2D (advanced imaging-MRI: other)
number
level : Ratio
Primary_Care_Services
Total number of primary care services per 1,000 person-years in the performance year. Primary care services are counted regardless of physician specialty. See Medicare Shared Savings Program Shared Savings and Losses and Assignment Methodology document for detail on the HCPCS and revenue center codes used to identify a primary care service visit
number
level : Ratio
Primary_Care_Services_With_A_PCP
Total number of primary care services provided by a primary care physician (PCP) per 1,000 person-years in the performance year. Defined as a qualifying visit with a primary care physician with a CMS specialty code of 1 (general practice), 8 (family practice), 11 (internal medicine), or 38 (geriatric medicine).
number
level : Ratio
Primary_Care_Services_With_A_Specialist
Total number of primary care services provided by a specialist per 1,000 person-years in the performance year. See Medicare Shared Savings Program Shared Savings and Losses and Assignment Methodology document for detail on the HCPCS and revenue center codes used to identify a primary care service visit and the specialty codes used to identify a physician specialist
number
level : Ratio
Primary_Care_Services_With_A_NP_PA_CNS
Total number of primary care services provided by a nurse practitioner (NP), physician's assistant (PA), or clinical nurse specialist (CNS) per 1,000 person-years in the performance year. Defined as a qualifying visit with practitioner with a CMS specialty code of 50 (nurse practitioner), 89 (clinical nurse specialist), and 97 (physician assistant).
number
level : Ratio
Primary_Care_Services_With_A_FQHC_RHC
Total number of primary care services provided at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) per 1,000 person-years in the performance year. See Medicare Shared Savings Program Shared Savings and Losses and Assignment Methodology document for detail on the HCPCS and revenue center codes used to identify a primary care service visit
number
level : Ratio
Number_of_CAH_IIs
Total number of Method II Critical Access Hospitals participating in the ACO in the performance year. Based on the ACO's certified participant list used in financial reconciliation and ACO-reported facility type.
integer
level : Ratio
Number_of_FQHCs
Total number of Federally Qualified Health Centers participating in the ACO in the performance year. Based on the ACO's certified participant list used in financial reconciliation and ACO-reported facility type
integer
level : Ratio
Number_of_RHCs
Total number of Rural Health Clinics participating in the ACO in the performance year. Based on the ACO's certified participant list used in financial reconciliation and ACO-reported facility type
integer
level : Ratio
Number_of_ETA_Hospitals
Total number of Electing Teaching Amendment Hospitals participating in the ACO in the performance year. Based on the ACO's certified participant list used in financial reconciliation and ACO-reported facility type
integer
level : Ratio
Number_of_Other_Facility_Types
Total number of other facilities participating in the ACO in the performance year. Based on the ACO's certified participant list used in financial reconciliation and ACO-reported facility type
integer
level : Ratio
Number_of_Participating_PCPs
Total number of primary care physicians (PCPs) that reassigned billing rights to an ACO participant in the performance year. Based on the ACO's certified participant list used in financial reconciliation and information in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
integer
level : Ratio
Number_of_Participating_Specialists
Total number of physician specialists that reassigned billing rights to an ACO participant in the performance year. Based on the ACO's certified participant list used in financial reconciliation and information in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
integer
level : Ratio
Number_of_Participating_Nurse_Practitioners
Total number of nurse practitioners that reassigned billing rights to an ACO participant in the performance year. Based on the ACO's certified participant list used in financial reconciliation and information in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
integer
level : Ratio
Number_of_Participating_Physician_Assistants
Total number of physician assistants that reassigned billing rights to an ACO participant in the performance year. Based on the ACO's certified participant list used in financial reconciliation and information in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
Total number of clinical nurse specialists that reassigned billing rights to an ACO participant in the performance year. Based on the ACO's certified participant list used in financial reconciliation and information in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
integer
level : Ratio
ACO1
Getting Timely Care, Appointments, and Information
number
level : Ratio
ACO2
How Well Your Providers Communicate
number
level : Ratio
ACO3
Patients’ Rating of Provider
number
level : Ratio
ACO4
Access to Specialists
number
level : Ratio
ACO5
Health Promotion and Education
number
level : Ratio
ACO6
Shared Decision Making
number
level : Ratio
ACO7
Health Status/Functional Status
number
level : Ratio
ACO8
Risk Standardized, All Condition Readmission
number
level : Ratio
ACO9
Ambulatory Sensitive Condition Admissions: Chronic Obstructive Pulmonary Disease or Asthma in Older Adults (AHRQ Prevention Quality Indicator (PQI)
Percent of PCPs who Successfully Meet Meaningful Use Requirements
number
level : Ratio
ACO13
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.
number
level : Ratio
ACO14
Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.
number
level : Ratio
ACO15
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.
number
level : Ratio
ACO16
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.
number
level : Ratio
ACO17
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco user.
number
level : Ratio
ACO18
Percentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.
number
level : Ratio
ACO19
Percentage of adults 50 - 75 years of age who had appropriate screening for colorectal cancer.
number
level : Ratio
ACO20
Percentage of women 50 through 74 years of age who had a mammogram to screen for breast cancer within 27 months.
number
level : Ratio
ACO21
Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated.
number
level : Ratio
ACO27
Percentage of patients 18 - 75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. Note that a lower performance rate is indicative of better quality.
number
level : Ratio
ACO28
Percentage of patients 18 - 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (< 140/90 mmHg) during the measurement period.
number
level : Ratio
ACO30
Percentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period.
number
level : Ratio
ACO31
Percentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital discharge.
number
level : Ratio
ACO33
Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have diabetes OR a current or prior Left Ventricular Ejection Fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy.
number
level : Ratio
ACO34
Stewardship of Patient Resources
number
level : Ratio
ACO35
Risk-adjusted rate of all-cause, unplanned hospital readmissions within 30 days for ACO-assigned beneficiaries who had been admitted to a skilled nursing facility (SNF) after discharge from their prior proximal hospitalization. Note that a lower performance rate is indicative of better quality.
number
level : Ratio
ACO36
Rate of risk-standardized, acute, unplanned hospital admissions among beneficiaries 65 years and older with diabetes who are assigned or aligned to the ACO. Note that a lower performance rate is indicative of better quality.
number
level : Ratio
ACO37
Rate of risk-standardized, acute, unplanned hospital admissions among beneficiaries 65 years and older with heart failure who are assigned or aligned to the ACO. Note that a lower performance rate is indicative of better quality.
number
level : Ratio
ACO38
Rate of risk-standardized acute, unplanned hospital admissions among beneficiaries 65 years and older with MCCs who are assigned or aligned to the ACO. Note that a lower performance rate is indicative of better quality.
number
level : Ratio
ACO39
Percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration.
number
level : Ratio
ACO40
Adult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatment.
number
level : Ratio
ACO41
Percentage of patients 18 - 75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period.
number
level : Ratio
ACO42
Percentage of the following patients—all considered at high risk of cardiovascular events—who were prescribed or were on statin therapy during the measurement period:
number
level : Ratio
DM_Comp
Percentage of patients who meet the numerator criteria of ACO-41 and do not meet the numerator criteria of ACO-27.
number
level : Ratio
Data Preview
ACO Year
ACO Number
ACO Name
ACO State
Start Date
Total Assigned Beneficiaries
Saving Rate
Min Saving Percentage
Benchmark Minus Expenditure
General Save Loss
Earned Save Loss
Quality Score
Updated Benchmark Expenditure
History Benchmark
Total Benchmark Expenditure
Total Expenditure
Advance Payment Amount
Advance Payment Recoupment
Quality Performance Share
Final Sharing Rate
Per Capita Exp All ESRD by Year1
Per Capita Exp All Disabled by Year1
Per Capita Exp All AGDU by Year1
Per Capita Exp All AGND by Year1
Per Capita Exp All ESRD by Year2
Per Capita Exp All Disabled by Year2
Per Capita Exp All AGDU by Year2
Per Capita Exp All AGND by Year2
Per Capita Exp All ESRD by Year3
Per Capita Exp All Disabled by Year3
Per Capita Exp All AGDU by Year3
Per Capita Exp All AGND by Year3
Per Capita Exp All ESRD Performance Year
Per Capita Exp All Disbled Performance Year
Per Capita Exp All AGDU Performance Year
Per Capita Exp All AGND Performance Year
Per Capita Exp Total Performance Year
CMS HCC Risk Score ESRD BY1
CMS HCC Risk Score Disabled BY1
CMS HCC Risk Score AGDU BY1
CMS HCC Risk Score AGND BY1
CMS HCC Risk Score ESRD BY2
CMS HCC Risk Score DIS BY2
CMS HCC Risk Score AGDU BY2
CMS HCC Risk Score AGND BY2
CMS HCC Risk Score ESRD BY3
CMS HCC Risk Score DIS BY3
CMS HCC Risk Score AGDU BY3
CMS HCC Risk Score AGND BY3
CMS HCC Risk Score ESRD Performance Year
CMS HCC Risk Score DIS Performance Year
CMS HCC Risk Score AGDU Performance Year
CMS HCC Risk Score AGND Performance Year
ESRD Person Years in Benchmark Year3
Disabled Person Years in Benchmark Year3
Aged Dual Person Years in Benchmark Year3
Aged Non Dual Person Years in Benchmark Year3
Total Person Years in Performance Year
ESRD Person Years in Performance Year
Disabled Person Years in Performance Year
AGED DUAL Person Years in Performance Year
AGED NON DUAL Person Years in Performance Year
Total Assigned Beneficiaries Age 0 To 64
Total Assigned Beneficiaries Age 65 To 74
Total Assigned Beneficiaries Age 75 To 84
Total Assigned Beneficiaries Age 85 Plus
Total Assigned Beneficiaries Female
Total Assigned Beneficiaries Male
Total Assigned Beneficiaries Race White
Total Assigned Beneficiaries Race Black
Total Assigned Beneficiaries Race Asian
Total Assigned Beneficiaries Race Hisp
Total Assigned Beneficiaries Race Native
Total Assigned Beneficiaries Race Other
Total Inpatient Expenditures
Short Term Care Hospital Expenditure
Long Term Care Hospital Expenditure
Inpatient Rehabilitation Facility Expenditures
Inpatient Psychiatric Hospital Expenditures
Hospice Expenditures
Skilled Nursing Facility or Unit Expenditures
Other Inpatient Expenditures
Outpatient Expenditures
Physician Supplier Expenditures
Ambulance Expenditures
Home Health Expenditures
Durable Medical Equipment Expenditures
Inpatient Hospital Discharges
Short Term Acute Care Hospital Discharges
LTCH Discharges
IRF Discharges
IPF Discharges
CHF Discharges
COPD Asthma Discharges
Bacterial Pneumonia Discharges
Short Term Acute Care Readmissions
Post Discharge Provider Visits 30 Day
Skilled Nursing Facility Discharges
Outpatient ED Visits
Inpatient ED Visits
CT Events
MRI Events
Primary Care Services
Primary Care Services With A PCP
Primary Care Services With A Specialist
Primary Care Services With A NP PA CNS
Primary Care Services With A FQHC RHC
Number of CAH IIs
Number of FQHCs
Number of RHCs
Number of ETA Hospitals
Number of Other Facility Types
Number of Participating PCPs
Number of Participating Specialists
Number of Participating Nurse Practitioners
Number of Participating Physician Assistants
Number of Participating Clinical Nurse Specialists
ACO1
ACO2
ACO3
ACO4
ACO5
ACO6
ACO7
ACO8
ACO9
ACO10
ACO11
ACO13
ACO14
ACO15
ACO16
ACO17
ACO18
ACO19
ACO20
ACO21
ACO27
ACO28
ACO30
ACO31
ACO33
ACO34
ACO35
ACO36
ACO37
ACO38
ACO39
ACO40
ACO41
ACO42
DM Comp
2016
A67373
Palm Beach Accountable Care Organization, LLC
Florida
2012-07-01
51150
0.09405282
0.021769977000000003
62751855
62751855.0
30540508.0
0.9932
13356
13352
667198021
604446165
0.5
0.4966
89520
13065
20651
11542
81990
12741
20113
11145
85010
12967
17963
10992
79171
11922
17058
11149
12099
1.084
1.27
1.122
1.217
1.0859999999999999
1.235
1.095
1.228
1.078
1.261
1.139
1.2309999999999999
1.0390000000000001
1.244
1.141
1.2309999999999999
371
3114
3761
43063
49957
352
2958
3596
43051
4362
20953
16741
9094
29670
21480
44999
2574
263
1978
20
1316
3036
2686
93
224
56
249
785
1665
5369
109
899
241
318
297
3.0
12
7
11
13
8
170
824
73
648
242
869
439
14765
5592
8443
714
16
206
232
69
82.63
92.47
90.96
84.2
65.79
75.98
72.16
14.93
12.83
15.22
85.71
87.54
92.19
85.49
91.91
98.3
84.76
87.94
89.74
98.56
10.65
84.92
90.94
100.0
95.81
32.51
17.71
52.36
69.19
52.93
98.8
8.33
80.99
91.52
74.9
2016
A38665
CCACO
New York, New Jersey
2012-04-01
9896
0.069573043
0.030103103
6391148
6391148.0
2797831.0
0.8934
9516
9686
91862414
85471266
0.5
0.4467
73589
9254
8498
6516
75474
10127
8721
6915
69031
9828
8147
6136
72003
8694
8112
6227
8854
0.973
1.078
0.833
0.9790000000000001
0.93
1.1520000000000001
0.82
0.9890000000000001
0.976
1.159
0.843
0.9540000000000001
0.9490000000000001
1.088
0.823
0.907
147
658
7511
1511
9654
157
577
7216
1705
874
3666
3619
1737
5944
3952
497
163
7682
77
2
1475
2269
2134
21
75
44
86
626
1263
4216
65
314
165
179
172
3
2
6
3
5
163
848
32
295
154
539
328
14777
8712
5853
179
32
91
176
11
1.0
75.9
88.18
86.72
80.03
55.87
68.05
66.28
14.78
3.14
15.17
90.16
69.59
77.68
62.17
93.75
98.03
62.39
59.77
49.84
96.24
11.29
77.43
81.82
97.03
77.61
17.39
18.2
47.91
59.25
39.35
78.48
41.89
73.67
38.43
2016
A76261
Hackensack Alliance ACO
New Jersey, New York
2012-04-01
29546
0.125987478
0.024045367999999998
50511463
50511463.0
22835022.0
0.9226
13917
13791
400924471
350413008
0.5
0.4613
126723
14045
23701
12309
127680
13975
19663
12073
96483
12549
17858
11325
95022
13013
16555
10917
12163
1.115
1.093
1.145
1.1179999999999999
1.117
1.169
1.126
1.15
1.104
1.131
1.064
1.102
1.015
1.149
1.044
1.107
204
1973
2319
24115
28809
235
1913
2153
24508
2712
13128
8738
4968
17466
12080
24590
1851
682
1075
14
1334
3567
3224
78
209
102
204
1332
2341
4267
89
563
195
298
278
2.0
10
8
10
8
6
173
838
95
584
229
795
307
12078
4026
7411
638
3
4.0
328
422
129
1.0
2.0
81.73
94.24
92.68
82.73
56.73
76.57
70.85
15.27
10.22
12.6
95.41
54.25
78.51
73.39
83.47
95.97
56.28
66.94
68.15
84.21
12.5
71.77
85.08
82.45
87.96
27.09
18.93
52.07
73.44
60.14
96.94
3.85
43.55
86.86
41.94
2016
A38596
NH Accountable Care Partners
New Hampshire, Maine, Massachusetts
2012-07-01
46616
0.01302615
0.022338311
6188979
0.9559
10460
10484
475119582
468930603
0.5
0.4779
87058
9468
17059
9293
84238
9582
17389
9620
86152
10388
18567
9555
85961
10438
17387
9517
10324
1.048
1.032
1.09
1.042
1.058
1.045
1.092
1.052
1.051
1.0659999999999998
1.114
1.028
1.03
1.034
1.103
1.02
187
6626
2250
36714
45424
180
6206
2179
36859
7600
20775
12207
6034
26393
20223
44932
292
152
134
23
1083
3479
2946
27
407
129
268
849
2564
2479
136
641
207
330
299
1.0
20
10
15
12
9
176
810
75
754
222
721
281
9253
3035
4011
1985
223
4.0
11.0
404
460
258
6.0
2.0
85.08
94.2
93.31
83.33
66.21
79.6
74.0
15.41
9.96
19.06
91.35
79.11
77.94
91.23
74.64
97.84
62.1
75.4
75.18
70.59
9.27
73.78
91.89
87.01
80.61
26.52
17.71
56.17
85.56
67.92
29.51
2.94
68.15
86.32
62.5
2016
A60892
Arizona Connected Care, LLC
Arizona
2012-04-01
7331
-0.232430295
0.033337337
-14473418
0.8776
8769
8465
62269929
76743347
0.5
0.4388
62939
7859
6660
7373
61475
8461
7601
7498
60960
8431
8132
7448
74272
10205
9811
9921
10808
0.983
1.078
0.769
0.977
0.996
1.097
0.757
0.996
0.9540000000000001
1.078
0.8270000000000001
0.987
0.96
1.126
0.742
1.0290000000000001
88
842
396
5498
7101
95
780
385
5841
1126
3507
1932
766
3912
3419
6422
169
51
374
121
194
3809
3208
107
450
75
168
709
1928
3806
151
376
207
360
322
3.0
25
8
10
7
10
172
809
67
773
216
733
327
9912
3033
4483
1204
1191
39.0
181
62
112
1.0
72.22
90.02
88.6
80.88
59.84
75.45
72.55
15.12
6.87
13.11
82.88
67.17
49.57
62.46
77.01
83.08
56.02
50.58
65.04
67.77
25.27
69.0
81.37
79.31
65.91
23.35
17.88
50.78
81.03
68.75
95.93
3.13
37.09
70.39
31.09
2016
A58483
Atlantic ACO
New Jersey, Pennsylvania
2012-04-01
62759
0.005184274
0.02
3554662
0.9359
11216
10928
685662592
682107930
0.5
0.46799999999999997
87450
10346
14979
9577
102065
10818
15750
9902
90477
10778
15668
9873
95946
10945
15599
10231
11158
1.006
1.081
1.033
1.044
1.04
1.113
1.061
1.075
1.0590000000000002
1.0759999999999998
1.043
1.044
1.026
1.058
1.046
1.068
369
5093
3102
48318
61130
417
5231
3210
52273
7082
28352
17833
9492
35969
26790
54673
3319
1491
761
20
2495
3607
3205
65
263
105
226
1227
1850
3935
98
413
192
306
284
2.0
13
8
13
7
5
176
829
97
583
235
718
263
11095
4274
6208
597
15
6.0
12.0
381
409
137
1.0
1.0
80.13
92.47
92.53
78.38
60.44
75.62
74.37
15.26
8.98
16.84
93.83
64.0
68.72
68.59
79.6
94.03
48.06
51.99
59.9
82.85
17.04
70.33
78.5
89.24
79.27
24.73
18.22
56.64
80.7
63.76
87.63
45.57
75.89
39.3
2016
A61599
Florida Physicians Trust, LLC
Florida
2012-04-01
6170
0.066647848
0.03565966
4469512
4469512.0
1981787.0
0.9049
11160
10972
67061614
62592102
0.5
0.4525
84688
9801
16338
9416
74453
9483
17520
9473
68654
10854
16129
9178
73543
10201
16054
9397
10416
1.063
1.1840000000000002
1.228
1.167
1.0959999999999999
1.2890000000000001
1.2209999999999999
1.172
1.03
1.28
1.1909999999999998
1.173
1.101
1.271
1.318
1.166
50
621
330
4832
6009
53
621
335
5000
832
2581
1818
939
3635
2535
5243
524
56
159
4
184
2755
2562
29
129
38
402
774
1619
4064
95
626
268
311
296
1.0
7
6
10
10
5
175
835
67
610
229
916
390
12964
5702
5696
1557
8
28
10
11
79.59
91.25
90.36
85.08
55.2
71.7
71.15
14.62
9.65
9.9
40.74
57.09
77.88
72.15
81.82
98.03
53.14
65.25
65.48
77.1
9.52
80.16
82.0
96.97
93.94
28.41
17.97
46.41
63.45
49.34
99.38
53.92
84.89
51.25
2016
A46707
Premier ACO Physicians Network, LLC
California
2012-04-01
9018
-0.03845691
0.030981982
-4811778
0.8426
14329
14396
125121284
129933062
0.5
0.4213
94361
11563
16295
10958
100233
12058
16212
10815
92446
13311
19920
10883
97046
13843
18525
11343
14881
1.0270000000000001
1.254
1.06
1.222
1.006
1.2229999999999999
1.058
1.212
1.033
1.28
1.104
1.209
1.042
1.27
1.078
1.157
180
1103
1555
5989
8732
181
1177
1726
5647
1591
3661
2380
1386
5142
3876
5955
858
889
689
20
607
5036
4132
650
245
197
434
2170
1938
4513
198
1159
265
392
348
17.0
12
15
15
9
7
185
776
123
706
282
670
320
11534
5109
6214
204
7
122
81
15
79.0
92.05
90.26
85.66
59.96
75.14
70.99
14.77
9.47
17.22
73.58
38.67
59.46
58.43
51.89
58.1
20.85
45.78
65.48
71.89
44.18
61.45
61.03
79.17
83.66
24.66
18.72
61.41
73.32
60.36
28.33
15.26
58.25
11.65
2016
A28708
Advocate Physician Partners Accountable Care, Inc.
Illinois
2012-07-01
139617
0.039039128
0.02
60680999
60680999.0
28924272.0
0.9728
11442
11270
1554363576
1493682577
0.5
0.4864
86267
10857
18539
9549
87819
10875
21131
9404
83681
10596
19177
9800
82111
10624
17795
9764
10995
1.048
1.153
1.068
1.056
1.035
1.14
1.1159999999999999
1.0490000000000002
1.0270000000000001
1.1
1.073
1.054
1.012
1.083
1.056
1.058
1307
13682
6643
112804
135850
1323
13605
7453
113469
18744
64497
38494
17882
81226
58391
112135
17396
2656
2638
67
4725
3479
3070
77
289
81
256
1133
1881
3588
131
683
210
351
326
2.0
15
9
12
13
7
179
820
100
654
252
754
292
9914
4556
4455
883
19
1.0
10.0
19.0
1305
1007
338
5.0
14.0
84.37
93.73
92.91
84.7
65.52
77.33
73.66
14.54
13.39
13.34
86.38
69.65
62.54
61.32
81.13
97.85
81.15
64.57
67.65
83.15
12.5
75.7
84.59
78.57
82.35
26.57
18.54
60.26
84.29
67.52
95.73
9.09
53.72
81.44
49.49
2016
A04423
Catholic Medical Partners-Accountable Care IPA, Inc.
Demos
