With the Medicare Shared Savings Program preparing to enter its fourth year in 2015, federal officials are recasting the list of quality metrics and providing "bonus payments" to incentivize year-to-year performance gains.
The Centers for Medicare & Medicaid Services' proposed rules for 2015 payments through Medicare B, which covers outpatient care, include several changes to the Medicare Shared Savings Program. With more than 300 healthcare organizations participating, MSSP is the largest of two accountable care programs CMS administers, in part because it is a risk-bearing contract with no downside. In the other one, CMS's Pioneer ACO program, participants benefit from gain-sharing but also face the risk of cost-sharing.
The proposed Medicare B rules both refresh and cull quality measures. A dozen new quality measures add patient outcome-based metrics to the list, including unplanned admissions for patients with diabetes, heart failure, or multiple chronic conditions.
The proposed quality measures also include post-discharge tracking of hospital patients to see whether they are admitted to skilled nursing facilities within 30 days of discharge.
Eight of the 33 MSSP quality measures that were adopted in 2011 are slated to be scrapped, mostly because they were considered redundant or out of step with best clinical practices. If CMS moves forward with its proposed changes, there would be a total of 37 MSSP quality standards next year, a net gain of four standards over the current year.