Medicare ACO - Web Interface Reporting Option

Starting in 2021, Accountable Care Organizations (ACOs) participating in the Shared Savings Program are required to report via the APM Performance Pathway (APP) for the purpose of assessing their quality performance for that program.


Under the APP, ACOs have the option to report the 10 CMS Web Interface measures or submit 3 eCQM or MIPS CQM measures. For more information about submitting 3 eCQM or MIPS CQM measures click here


Please see below for more information about the CMS Web Interface Measures set.

  • 10 Web Interface Quality Measures

    • Care-2: Falls: Screening for Future Fall Risk

    • DM-2: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (9%)

    • HTN-2: Controlling High Blood Pressure

    • MH-1: Depression Remission at 12 Months

    • Prev-5: Breast Cancer Screening

    • Prev-6: Colorectal Cancer Screening

    • Prev-7: Influenza Immunization

    • Prev-10: Tobacco Use: Screening and Cessation Intervention

    • Prev-12: Screening for Depression and Follow-up Plan

    • Prev-13: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

  • 2 Claims-Based Measures

    • Hospital-Wide, 30-day All-Cause Unplanned Readmission (HWR)​

    • Risk Standardized:  All-Cause Unplanned Admissions for Multiple Chronic Conditions (MCC)

  • 1 CAHPS for MIPS

 

TABLE OF CONTENTS

Step 1:  Security Official Training (ACO Leadership)

Step 2:  Learn the Measures and Patient Selection

Step 3:  Select Data Import Types for all Facilities

Step 4: SFTP Account Setup

Step 5:  Complete Gap Analysis, Scoring and Scorecard Training

Step 6:  Random Sample

Step 7: GPRO Reporting

Resources

Step 1: Security Official Training (ACO Leadership)

Your Security Official is the top level in the hierarchy of user roles and permissions. This person will manage user account credentials, data import priorities and maintain facility and provider network configuration in the solution. You may have multiple users with the Security Official role.

  • My Team is used to set-up new users or update access for current users. 

  • Network Manager is used to configure: 

    • Assignment for patients on Commercial Membership Rosters.​

    • Assignment for patients on ACO Attribution List - HALR (Historical Assignment) and QALR (Quarterly Assignment List Report) files.

    • Create Divisions, facilities, locations and providers.

      ​

​​

 

Step 2: Learn the Measures and Patient Selection 

 

ACO Management Team and all participating providers should get familiar with the measures. 

 

The Measures Overview Document will bring you to a spreadsheet which contains:

  • A 2021 measure summary of CMS Web Interface measures and QPP APM Entity Measures​

  • A 2022 measures summary for the QPP APM Entity Measures

  • Measures Scoring Weight

  • Definition of Data Sources

  • 2021 Data Sources overview by measures

  • Quality Data Code (QDC) Worksheet for using claims (2021 performance Year)

  • Summary of the Administrative Claims Measures

  • FHIR Resources Summary

The Measures Specifications is a summary of the quality measures including links to the CMS documents.

Step 3: Select Data Import Types for ALL Facilities

 

Year-Round Tracking

 

The data sources available for selection include:

  • Medicare claims - Pulling applicable CPT, ICD-10 or HCPCS codes from claims per CMS Web Interface Measure Specification. ACO leadership can choose to use Claims to close a measure with claims or just show applicable information.

  • QRDA Category I Files (Single Patient Report) Individual patient-level report that contains data defined in the measure.  (Click here for more QRDA information in the eCQI Resource Center)

  • SMART on FHIR (Cerner, Epic)

  • Flat File Imports - Health Endeavors can import quality measure answers from a flat file template. These files are imported twice per month. (See the File Processing Calendar)

  • Spec File Import - Automation using our Business Requirements Documents (BRD)

    • All measure responses can be imported using the tool.​

    • Select the module from the sidebar.

    • Upload the properly formatted file that contains the patient HICN, MBI or Patient First Name, Last Name and DOB.

    • Each measure contains a template to be used for the data.

    • An answer legend will be provided for each measure to detail the responses.

    • You will be provided a preview of actions to be taken prior to any updates being committed.

    • The process is limited to 1000 records per upload.

  • Single File Import - ​

    • Only positive (performance) measure responses can be uploaded with the tool.​

    • Select the module and related question you would like to complete.

    • Upload the properly formatted file that contains the patient HICN, MBI or Patient First Name, Last Name and DOB.

    • You will be provided a preview of actions to be taken prior to any updates being committed.

    • The process is limited to 1000 records per upload.

  • Manual Key - Manually Enter quality measure answers in Health Endeavors.

Step 4: SFTP Account Setup (Optional)

 

The participating provider will need a SFTP account to securely  transfer quality measure data for QRDA and Flat File imports. 

  

Please complete the SFTP Connection Worksheet and email to gretchena@healthendeavors.com. Once Health Endeavors has completed setup the user will receive an email with login and final setup details.

Step 5: Complete Gap Analysis, Scoring and Scorecard Training

 

  • Year-Round Gaps in Care Analysis - Proactive, year-round strategy for identifying, disease and wellness gaps in care significantly improves your quality performance 

ACO will meet the Shared Savings Program quality performance standard if: 

  • For performance years 2021 and 2022, the ACO achieves a quality performance score that is equivalent to or higher than the 30th percentile across all MIPS Quality performance category scores; and

​​

  • For the 2023 performance year and subsequent performance years, and ACO achieves a quality performance score that is equivalent to or higher than the 40th percentile across all MIPS Quality performance category scores.

ACOs that meet the quality performance standard are eligible to share in savings at the maximum sharing rate, and ACOs in 2-sided models share in losses based on their quality score or at a fixed percentage based on track. ACOs that do not meet the quality performance standard are ineligible to share savings and owe the maximum amount of shared losses, if applicable. 

 

Step 6: Random Sample

Using data from CMS claims and CMS Medicare enrollment and demographics, patients will be selected for each measure sample who meet the denominator criteria and patient eligibility. Patients are sampled into at least one measure, but may be sampled into more than one measure, and will be assigned a number (referred to as the patient’s “rank,” which indicates the order in which the patient was sampled into that measure). All organizations, regardless of size, are required to completely and accurately report on a minimum of 248 consecutively ranked and confirmed Medicare patients for each measure. However, if the pool of eligible sampled patients is less than 248, then an organization is required to report on all sampled patients. 

 

If possible, an “oversample” will be provided for each measure. This means that each sample will include more patients than are needed to meet the reporting requirement of 248. For the 2021 performance year, 9 of the 10 measures may have an oversample of 616 patients. The PREV-13: Statin Therapy for the Prevention and Treatment of Cardiovascular Disease measure may have an oversample of 750 patients. Please note that the reporting requirement for consecutively ranked and confirmed Medicare patients remains at 248 for PREV-13 despite the larger sample size. If the sampling target of 616 or 750 patients cannot be met for any measure, it will have a smaller sample size that includes all patients who meet measure eligibility. There are denominator exclusion and exception criteria for certain measures that could prevent an organization from meeting the sampling target for a measure.

Step 7:  GPRO Reporting (Submissions to CMS)

 

GPRO reporting for performance year 2021 is January 3, 2022 - March 31, 2022. CMS will release your random sample towards the very end of December or first of January. Once the sample has been released Health Endeavors will load into our portal for your team to begin working on reviewing these specific patients and completing any missing data.

Once your team is satisfied with your responses Health Endeavors will begin submitting the data to CMS. 

Resources