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Accounting for Social Risk Factors in Medicare Payment Identifying Social Risk Factors (2016) / Chapter Skim
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Appendix A--Overview of Medicare Value-Based Payment Programs
Pages 85-92

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From page 85...
... The algorithm used to calculate excess readmissions captures an individual hospital's performance compared to that of hospitals nationally over a 3-year performance period. The excess readmission measure is then risk adjusted using a methodology endorsed by the National Quality Forum (NQF)
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From page 86...
... . Hospital Value-Based Purchasing Clinical process measures include measures related to getting appropriate treatments in a timely manner (e.g., receiving angioplasty within 90 minutes of hospital arrival for acute myocardial infarction [AMI]
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From page 87...
... . Although the precise value modifier calculation methodology will change slightly between 2015 and 2016, for physicians in category 1, quality is assessed using a composite score covering six domains (effective clinical care, person- and caregiver-centered experience and outcomes, community/population health, patient safety, communication and care coordination, and efficiency and cost reduction)
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From page 88...
... requires CMS to use quality measures assessing anemia management, dialysis adequacy, and other measures specified by the Secretary of the Department of Health and Human Services (HHS) regarding iron management, bone mineral metabolism, vascular access, and patient satisfaction (CMS, 2015c)
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From page 89...
... To do so, CMS first calculates a risk measures for each enrollee, using the CMS hierarchical condition category model, which includes demographics (age and sex) , clinical comorbidities, Medicaid status, disabled status, and working aged status,1 and then multiplies it for the base rate for enrollees.
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From page 90...
... CMS proposed adopting the NQF-endorsed 30-day allcause readmission measure as the performance measure on which FY 2019 incentive payments will be based, and CMS is soliciting comment on implementing the measure for SNF incentive payment application (CMS, 2015g)
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From page 91...
... 2014. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR)
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From page 92...
... Washington, DC: National Quality Forum.
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Key Terms

  • medicare payment
  • incentive program
  • reporting measures
  • shared savings
  • clinical measures

  • payment programs
  • performance score
  • reporting requirements
  • calculated using
  • accessed october

  • disease quality
  • quality incentive
  • incentive payment
  • national quality
  • calculated based

  • total performance
  • government accountability
  • cms calculates
  • renal disease
  • reduction program

  • modifier calculated
  • quality tiering
  • hospitals received
  • patient safety
  • quality forum

  • eligible professionals
  • accountability office
  • quality reporting
  • medicare shared
  • excess readmissions


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