This report commissioned by the Centers for Medicare and Medicaid Services describes the quality measurement and reporting requirements for the Physician Group Practice Demonstration. The demonstration has become the basis for designing the proposed Medicare Shared Savings Program accountable care organizations.
The 32 measures being used in the Physician Group Practice demonstration are HEDIS measures, including ten measures related to patients with diabetes, ten for patients with congestive heart failure, seven for patients with coronary heart disease, and five preventive measures for all patients. Only the diabetes measures are required for the first year, with the addition of the congestive heart failure and coronary heart disease measures in the second year, and all measures in the third year.
The report also details the complex weighting of the measures to calculate eligibility for any potential shared savings. In the first year, the weighted quality measure scores count 30% towards shared savings, with the percentage increasing to 40% in the second year and to 50% in the third year. This means that quality improvement will increasingly be the basis of any eligibility for shared savings as the demonstration proceeds.
The report also contains detailed technical specifications for sampling data, exclusions and other calculations.