A Brief Introduction to ACO Quality Measures

Tim Buxton, MBA, CPC, CIC, COC, CRC, CCS, CHP

December 14, 2015

Affordable Care Organizations (ACO’s) are much in the news; but what is an ACO, and how can we measure its success?


ACO’s have been established as interwoven healthcare entities with the intent to coordinate high quality care at a cost savings. They treat traditional Medicare patients, and are compensated by sharing in the savings the ACO achieves for Medicare. One CMS measurement of an ACO achieving its goals are the application and requirement for reporting of Quality Measures. Each ACO must demonstrate that it has met certain requirements regarding the care and satisfaction of its patients.


Certain of the ACO Quality Measures are actively gathered by the ACO’s themselves and reported to CMS through an online portal known as GPRO. Staff at the ACO’s will gather and review medical records to produce evidence that certain levels of care have been met (as described below). The relevant data may be entered line-by-line on the CMS website, or uploaded in bulk via files in XML format. The GPRO submissions period is extremely short, only mid-January through mid-March for the previous year’s services.


CMS looks specifically at the following Quality Measures, divided into four Domains:

Patient/Caregiver Experience
o These Measures are gathered entirely through patient CAHPS surveys.
o Getting Timely Care, Appointments and Information
o How Well Your Doctors Communicate
o Patients’ Rating of Doctor
o Access to Specialists
o Health Promotion and Education
o Shared Decision Making
o Health Status/Functional Status

• Care Coordination/Patient Safety
o These Measures are gathered through a combination of Claims Data, Administrative Data, and Medical Record reviews in the GPRO reporting process.
o All Condition Readmissions
o ASC Admissions: COPD or Asthma in Older Adults
o ASC Admission: Heart Failure
o Percent of PCPs who Qualified for EHR Incentive Payment
o Falls: Screening for Fall Risk
o Documentation of Current Medications in the Medical Record

For the full list of quality measures and more detailed information about Affordable Care Organizations, see full blog article here 


Tags: HIX, RADV Audit, ACO Quality Measures, affordable care

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