ACO Performance Measures

As we learn more about ACOs I’ll try to post more information.  I really liked this article from the New England Journal of Medicine – Launching Accountable Care Organizations – The Proposed Rule for Medicare Shared Savings Program.

They have a great slide outlining the proposed measures for ACO quality performance measures.  I thought I’d rewrite some of the points below to give us a brief snapshot of what the U.S. Health and Human Services (HHS) meant when they said ACO’s will be rewarded when they “lower growth in health care costs while meeting performance standards on quality of care and putting patients first.”  The following are the standards being considered:

Patient and caregiver experience

  • timely care appointments and information
  • good doctor communication
  • helpful, courteous, and respectful staff
  • health promotion and education
  • shared decision making

Care coordination – transitions

  • 30-day post discharge physician visit
  • medication reconciliation

Care coordination – information systems

  • % of Primary Care Physicians (PCP) meeting HITECH meaningful use requirements (basically implementing health IT such as electronic medical records)
  • % PCPs using clinical decision support
  • % of PCPs using electronic prescribing

Patient Safety

  • health care acquired conditions (e.g. – infections, falls, or objects retained after surgery)

Preventive Health

  • Immunizations and vaccinations
  • mammography screening
  • colorectal cancer screening
  • cholesterol monitoring
  • tobacco use and intervention
  • depression screening

At risk populations (diabetes, heart failure, coronary artery disease, hypertension, COPD, and frail elderly)

  • Diabetes – Hemoglobin A1c, cholesterol, blood pressure, microalbuminuria, eye exam, foot exam
  • Heart failure – Left ventricular functioning assessment and testing, weight measurement, patient education, and others
  • Coronary artery disease (CAD) – oral antiplatelet therapy, prescriptions for lowering LDL cholesterol, beta-blockers for certain patients, and others
  • Hypertension – blood pressure control rates, plan of care
  • COPD – spirometry evaluation, smoking cessation counseling, bronchodilator therapy
  • Frail Elderly – screen for falls, osteoperosis management, and others

Some of these measurements are concrete such as measuring blood pressure and cholesterol or how many physicians in the ACO are meeting the meaningful use requirements (to be discussed in a series of posts after this).  Others are quite theoretical such as measuring communication with doctors, patient education, shared decision making, or even depression screening.  Will patients and caregivers be given forms to fill out their perception of their experiences?  Does patient education simply mean givng a patient a brochure or referring them to a website? Or does it mean something more substantial?  How do we evaluate shared decision making?  What tools will we use for each screening?  For instance, depression screening, will there be a series of questions doctors must ask to determine determine if a patient is depressed?

In practice, what do these measures mean, will they actually give us a picture of ACO performance?  What savings will ACOs actually see?  Will we see health costs cut? And regardless, whichever performance measurements are ultimately selected for the final rule, will our health actually improve?


2 Responses to ACO Performance Measures

  1. […] more trend that makes me worry is the rise in hospitalists as we start to develop Accountable Care Organizations (ACOs).  I don’t want to go into too much detail here but I would just say that I have […]

  2. […] about Accountable Care Organizations (ACOs) in previous posts (Accountable Care Organizations and ACO Performance Measures) which will come to fruition next year.  This week, the Health and Human Services Department […]

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