Medicare ACO Quality Performance for 2013-2015 Results
Quality Measures to Assess Healthcare ACO
Keywords
Medicare Shared Savings Program
ACO
ACO Healthcare
Medicare ACO
Healthcare ACO
Shared Savings Program
Medicare Shared Savings Program Results
Medicare Shared Savings Program Performance Year 2013-2015 Results
This dataset contains the results of Medicare Shared Savings Program Performance Accountable Care Organizations (ACO) coverage for years 2013, 2014 and 2015.
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This dataset presents data on Calendar Year 2015 financial reconciliation and quality performance results for ACOs with 2012, 2013, 2014 and 2015 agreement start dates. ACOs that generated savings earned a performance payment if they met the quality standard. Quality performance for ACOs with 2015 start dates that are in their first performance year is based on complete and accurate reporting of all required quality measures for calendar year 2013-2015.
Participation in ACOs creates incentives for health care providers to work together voluntarily to coordinate care and improve quality for their patient population. Since the 2011 Shared Savings Program final rule, updates have been made to the Shared Savings Program quality measures, scoring, and quality performance standard have been made in subsequent Shared Savings Program and Physician Fee Schedule rules.
ACOs are required to completely and accurately report quality data that are used to calculate and assess their quality performance. In addition, in order to be eligible to share in any savings generated, an ACO must meet the established quality performance standard that corresponds to its performance year. CMS most recently updated the quality measure set in the 2016 Physician Fee Schedule Final Rule by adding a Statin Therapy for the Prevention and Treatment of Cardiovascular Disease measure in the Preventive Health Domain to address National Quality Strategy and CMS Strategy goals and to align with PQRS and the Million Hearts Initiative. This document presents the 34 quality measures used to assess ACO quality performance for the 2016 quality reporting year ACOs participating in the Shared Savings Program.
The dataset mentioned plays a crucial role in supporting applications of Generative AI in healthcare by enhancing terminology accuracy and facilitating better communication among medical professionals and patients.
About this Dataset
Data Info
Date Created
2014-11-06
Last Modified
2017-03-30
Version
2017-03-30
Update Frequency
Irregular
Temporal Coverage
2015
Spatial Coverage
United States
Source
John Snow Labs; Centers for Medicare and Medicaid Services;
What is an ACO?, Medicare ACO Quality Performance for 2013-2015 Results, Quality Measures to Assess Healthcare ACO
Data Fields
Name
Description
Type
Constraints
ACO_Year
Coverage year of Medicare Shared Savings Program Performance Accountable Care Organizations (ACO) (2013, 2014 and 2015)
date
-
ACO_Number
ACO Number assigned to groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.
string
-
ACO_Organization_Name
ACO Legal or Business Name
string
-
Beneficiaries_State
States where beneficiaries reside
string
-
Agreement_Start_Date
Start date of ACO agreement
date
-
Is_Participating_In_Advance_Payment_Model
ACO Participation In Advance Payment Model
boolean
-
Total_Assigned_Beneficiaries
Total number of assigned beneficiaries
integer
level : Ratio
Total_Benchmark_Expenditures
Benchmark total expenditures in dollars
number
level : Ratio
Total_Expenditures
Total expenditure in dollars
number
level : Ratio
Difference_Of_Expenditures
Shows total benchmark minus from assigned beneficiary expense in dollars
number
level : Ratio
Difference_Percentage
Shows total benchmark minus from assigned beneficiary expense in percentage
number
level : Ratio
Generated_Savings_Or_Losses
Shows generated saving or loss in dollars
number
level : Ratio
Earned_Shared_Savings_Payments
Earned shared savings payments or owe loss in dollars
number
level : Ratio
Is_Reported_Quality_Successful
Does the reported quality is successful or not
boolean
-
Quality_Score_Percentage
ACO quality score shown in percentage
number
level : Ratio
ACO_Performance_Result_1
Getting Timely Care, Appointments, and Information
number
level : Ratio
ACO_Performance_Result_2
How Well Your Providers Communicate
number
level : Ratio
ACO_Performance_Result_3
Patients’ Rating of Provider
number
level : Ratio
ACO_Performance_Result_4
Access to Specialists
number
level : Ratio
ACO_Performance_Result_5
Health Promotion and Education
number
level : Ratio
ACO_Performance_Result_6
Shared Decision Making
number
level : Ratio
ACO_Performance_Result_7
Health Status/Functional Status
number
level : Ratio
ACO_Performance_Result_8
Risk Standardized, All Condition Readmission
number
level : Ratio
ACO_Performance_Result_9
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
ACO_Performance_Result_12
Accountable care organizations performance results 12 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_13
Percentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.
number
level : Ratio
ACO_Performance_Result_14
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
ACO_Performance_Result_15
Percentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.
number
level : Ratio
ACO_Performance_Result_16
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
ACO_Performance_Result_17
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
ACO_Performance_Result_18
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
ACO_Performance_Result_19
Percentage of adults 50 - 75 years of age who had appropriate screening for colorectal cancer.
number
level : Ratio
ACO_Performance_Result_20
Percentage of women 50 through 74 years of age who had a mammogram to screen for breast cancer within 27 months.
number
level : Ratio
ACO_Performance_Result_21
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
ACO_Performance_Result_22
Accountable care organizations performance results 22 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_23
Accountable care organizations performance results 23 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_24
Accountable care organizations performance results 24 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_25
Accountable care organizations performance results 25 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_26
Accountable care organizations performance results 26 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_27
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
ACO_Performance_Result_28
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
ACO_Performance_Result_29
Accountable care organizations performance results 29 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_30
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
ACO_Performance_Result_31
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
ACO_Performance_Result_32
Accountable care organizations performance results 32 for: Coronary Artery disease: Angiotensin- Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Therapy—Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%).
number
level : Ratio
ACO_Performance_Result_33
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.