Attachment_J.1(b)_QIN-QIO_Evaluation_Measures_Table.xlsx
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- HHSM-500-2014-RFP-QIN-QIO
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Cover Page
RFP NO. HHSM-500-2014-RFP-QIN-QIO
SECTION J, ATTACHMENT J.1(b)
TASK ORDER 001, EVALUATION MEASURES TABLES
Task B.1.
| TASK B.1. – IMPROVING CARDIAC HEALTH | ||||||
| TBBLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline** | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| B.1-1 Blood Pressure Control | Percentage of patients whose blood pressure was adequately controlled. | N = Total number of patients with BP controlled, per recommended guidelines. | PQRS/EHRs and reported through DDST | 08/01/2014 through 1/31/15 | 2% | 2/1/15 through 7/31/15 | 15% | 8/1/15 through 7/31/16 | 30% | 8/1/16 through 7/31/17 | 65% | 8/1/17 through 7/31/18 | 70% | 02/01/2015 through 12/31/18 |
| B.1.2.2, B.1.5.2, B.1.5.3 | (EHR Users only) | |||||||||||||
| (PQRS #236) | D = Total number of patients with a diagnosis of hypertension (HTN). |
| B.1-2 Smoking Screening | Percentage of patients who are screened about tobacco use at least one time within 24 months. | N = Total number of patients screened. | PQRS/EHRs and reported through DDST | 08/01/2014 through 1/31/15 | 2% | 2/1/15 through 7/31/15 | 20% | 8/1/15 through 7/31/16 | 45% | 8/1/16 through 7/31/17 | 65% | 8/1/17 through 7/31/18 | 70% | 02/01/2015 through 12/31/18 |
| B.1.2.2, B.1.5.2 | (EHR Users only) | |||||||||||||
| (PQRS #226) | D= Total number of patients managed by the participating practitioners |
| B.1-3 Smoking Cessation Counseling | Percentage of patients identified as tobacco users who are provided with cessation counseling intervention. | N = Total number of patients identified as smokers who are provided with cessation counseling. | PQRS/EHRs and reported through DDST | 08/01/2014 through 1/31/15 | 2% | 2/1/15 through 7/3/15 | 20% | 8/1/15 through 7/31/16 | 45% | 8/1/16 through 7/31/17 | 65% | 8/1/17 through 7/31/18 | 70% | 02/01/2015 through 12/31/18 |
| B.1.2.2, B.1.5.2 | (EHR Users only) | |||||||||||||
| (PQRS #226) | D = Total number of patients identified as smokers who are managed by the participating practitioners. |
&"Arial,Regular"&14QIN-QIO Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO Task Order 001, Attachment B Evaluation Measures Table
* N=Numerator D= Denominator ** Baseline determined from the recruited CEHRT users.
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
* N=Numerator D= Denominator
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
Task B.2.
| TASK B.2. – EVERYONE WITH DIABETES COUNTS | Each of the following Minimum Performance Criteria contained in Task B.2 must be met for each state/territory in the service areB. | |||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| B.2-1 Clinical Outcomes | Percentage of clinical outcome data for Medicare beneficiaries who complete diabetes self-management education (DSME) classes through EDC. Clinical outcomes are: HbA1c, Lipids, Eye Exam, Blood Pressure and Weight. The goal is to obtain repeated measurements on the same beneficiaries longitudinally over time. | N = Each individual clinical measure. | Patient Medical Records | N/A | 2% | 8/1/2014 – 6/30/2015 | 4% | 8/1/2014 –06/30/2016 | 7% | 8/1/2014 –06/30/2017 | 9% | 8/1/2014 –06/30/2018 | 10% | 8/1/2014 – 12/31/2018 |
| Task B.2, Sections B & G; & Task B.2.5.2. | D = Medicare beneficiaries who complete DSME classes. |
| B.2-2 Physician Recruitment | Percentage of physician practices recruited to participate in EDC. | N = Number of recruited physician practices. | DDST | N/A | 10% | 5/1/2015 – 7/31/2015 | 10% | 5/1/2016-7/31/2016 | 10% | 5/1/2017 – 7/31/2017 | 100% | 5/1/2018 – 7/31/2018 | 100% | Nov. 1, 2018 – Jan. 31, 2019 |
| Task B.2, Sections B & G; & Task B.2.8.1 | D = Number in QIO contract taken from QIO’s CMS approved proposal. (Sec. J. – x). Number must increase quarterly as directed in SOW, (see Table in SOW). |
| B.2-3 Beneficiaries Completing DSME Classes | Percentage of New Beneficiaries Completing DSME | N= Number of Medicare beneficiaries who complete DSME classes | DDST | N/A | 4% | 5/1/2015 – 7/31/2015 | 7% | 5/1/2016-7/31/2016 | 7% | 5/1/2017 – 7/31/2017 | 7% | 5/1/2018 – 7/31/2018 | 7% | Nov. 1, 2018 – Jan. 31, 2019 |
| Task B.2, Sections B & G; & Tasks B.2.3 and B.2.8.3 | D= Number in QIO contract taken from CMS approved proposal (Sec. J – x) |
&"Arial,Regular"&14QIN-QIO 11th SOW
Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
Task B.3.
| TASK B.3. – USING IMMUNIZATION INFORMATION SYSTEMS - RESERVED | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| B.3-1 Influenza Immuniation | Percentage of Medicare beneficiaries who received an influenza immunization | N = Medicare beneficiaries who received influenza immunization. | Immunization registry and recruited practitioner offices. | Two months prior to contract award. | N/A | N/A | 12% reduction in quality deficit. | 8/1/14 through 3/31/16 | 25 % reduction in quality deficit. | 8/1/14 through 3/31/17 | 37% reduction in quality deficit. | 8/1/14 through 3/31/18 | 50% reduction in the quality deficit, towards a goal of 90%. | 08/01/2014 - 1/31/19 |
| Task B.3, Section B | Exclusion: Documented medical reason(s) for not receiving influenza immunization. Documented patient reason for not receiving influenza immunization | D = Total number of eligible Medicare beneficiaries in the recruited practitioner offices (POs). |
| B.3-2 Pneumococcal Immunization | Percentage of Medicare beneficiaries who received a pneumococcal immunization. | N = Medicare beneficiaries who received pneumococcal immunization. | Immunization registry and recruited practitioner offices. | Two months prior to contract award. | 10% reduction in quality deficit. | 8/1/14 through 7/31/15 | 20% reduction in quality deficit. | 8/1/14 through 7/31/16 | 30% reduction in quality deficit. | 8/1/14 through 7/31/17 | 40% reduction in quality deficit. | 8/1/14 through 7/31/18 | 50% reduction in the quality deficit, towards a goal of 90%. | 08/01/2014-1/31/19 |
| Task B.3, Section B | Exclusion: Documented medical or other reason for not giving pneumococcal immunization. | D = Total number eligible Medicare beneficiaries in recruited POs. |
| B.3-3 Pracitioner Offices Recruited | Percentage of practitioner offices recruited. | Recruit 50% POs during the first 12 months of the contract. Recruit 95% by the 24th month of the contract. Maintain 95% thereafter. | QIO | N/A | 50% of recruitment goal. | 8/1/14 through 7/31/15 | 95% of recruitment goal. | 8/1/14 through 7/31/16 | Maintain 95% recruitment | 8/1/14 through 7/31/17 | Maintain 95% recruitment | 8/1/14 through 7/31/18 | 95% of recruitment goal met. | 8/01/2014 through 7/31/19 |
| Task B.3, Section B; & Tasks B.3.2. and B.3.5.3. |
| B.3-4 Practitioner Offices Reporting at least once | Percentage of recruited practitioner offices that report electronically at least once. | N=POs submitted data once. | Immunization registry | N/A | 95% of recruited POs submitted data once. | 8/1/16 through 1/31/19 |
| Task B.3, Section B; & Tasks B.3.2., B.3.5.3., and B.3.5.4. | D=POs recruited |
| B.3-5 Practitioner Offices Reporting at least quarterly | Percentage of recruited practitioner offices that report electronically on a quarterly basis. | N=POs submitted data quarterly. | Immunization registry | N/A | 95% of recruited POs submitted data quarterly. | 8/1/16 through 1/31/19 |
| Task B.3, Section B; & Tasks B.3.2., B.3.5.3., and B.3.5.4. | D=POs recruited. |
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
Task B.4
| TASK B.4 – MEANINGFUL USE OF HIT AND COLLABORATING WITH RECs | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| B.4-1 Recruitment | Percentage of recruited EPs, EHs and CAHs using CEHRT with signed agreements within each state or territory | N = Number of practitioners/providers using CEHRT with signed agreements | QIO Collected | N/A | 60% | August 1, 2014 -July 31, 2015 | 75% | August 1, 2014-July 31, 2016 | 90% | August 1, 2014-July 31, 2017 | 100% | August 1, 2014-July 31, 2018 | 100% | August 1, 2014 – December 31, 2018 |
| Task B.4, Section B; & Task B.4.4 | D = Total number of practitioners/providers using CEHRT |
| B.4-2 Provider Technical Assistance | Percentage of recruited EPs, EHs and CAHs using CEHRT receiving technical assistance within each state or territory | N = Number of recruited EPs, EHs and CAHs using CEHRT receiving technical assistance within each state or territory | QIO Collected | N/A | 10% | August 1, 2014 -July 31, 2015 | 25% | August 1, 2014-July 31, 2016 | 50% | August 1, 2014-July 31, 2017 | 75% | August 1, 2014-July 31, 2018 | 75% | August 1, 2014 – December 31, 2018 |
| Task B.4, Section B; & Task B.4.5 | D = Total Number of recruited EPs, EHs and CAHs using CEHRT with signed agreements within each state or territory |
| B.4-3 Educational Sessions | Percentage of recruited practitioners/providers attending QIO’s educational sessions and the Learning and Action Network | N = Number of recruited EPs, EHs and CAHs attending QIO’s educational sessions and the Learning and Action Networks (as outlined in task 1) within each state or territory | QIO Collected | N/A | 30% | August 1, 2014 -July 31, 2015 | 45% | August 1, 2014-July 31, 2016 | 60% | August 1, 2014-July 31, 2017 | 80% | August 1, 2014-July 31, 2018 | 90% | August 1, 2014 – December 31, 2017 |
| Task B.4, Section B; & Tasks B.4.5 & B.4.6 | D = Total number of recruited EPs, EHs and CAHs with signed agreements within each state or territory (including those without CEHRT) |
| B.4-4 Quality Improvement and HIT Advancement (Improved Outcomes) | Percentage of recruited EPs, EHs and CAHs that received TA that meet EHR Incentive Programs clinical quality measures reporting requirements post TA within each state or territory | N = Number of recruited EPs, EHs and CAHs who received TA and have met EHR Incentive Programs clinical quality measures reporting requirements within each state or territory | QIO Collected | N/A | N/A | N/A | N/A | N/A | 50% | Eligible Professional: January 1, 2015-December 31, 2015; | 75% | Eligible Professional: January 1, 2016-December 31, 2016; | 75% | Eligible Professional: January 1, 2016-December 31, 2016; |
| Task B.4, Section B; & Tasks B.4.5 & B.4.6 | D = Total Number of recruited practitioners/providers using CEHRT and who received technical assistance | Eligible hospitals: October 1, 2015 – September 30, 2016 | Eligible hospitals: October 1, 2016 – September 30, 2017 | Eligible hospitals: October 1, 2016 – September 30, 2017 |
| B.4-5 Collaboration for Patient Engagement | Percentage of recruited practitioners/providers working to establish an electronic connection with beneficiaries/family representative | N = Number of recruited EPs, EHs and CAHs that established an electronic connection with beneficiaries/family representative within each state or territory | QIO Collected | N/A | N/A | August 1, 2014 -July 31, 2015 | N/A | August 1, 2014-July 31, 2016 | 5% for EPs and 10% for EHs and CAHs | August 1, 2014-July 31,2017 | 10% for EPs and 20% for EHs and CAHs | August 1, 2014-July 31, 2018 | 20% for EPs and 30% for EHs and CAHs | August 1, 2014–December 31, 2018 |
| Task B.4, Section B; & Task B.4.6 | D = Total number of recruited EPs, EHs and CAHs using CEHRT within each state or territory |
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
Task C.1.
| TASK C.1 – REDUCING HEALTHCARE-ACQUIRED INFECTIONS (HAIs) IN HOSPTIALS | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| C.1-1 CLABSI Standardized Infection Ratio | The number of CLABSI cases in a facility over the predicted number of CLABSI cases for that facility over a specified amount of time | N = The number of observed CLABSI cases for a participating provider. | NHSN | N/A | SIR of more than or equal to 60% of the national benchmark | 8/1/14 – 5/31/15 | SIR of more than or equal to 70% of the national benchmark | 6/1/15 – 5/31/16 | SIR of more than or equal to 80% of the national benchmark | 6/1/16 – 5/31/17 | SIR of more than or equal to 90% of the national benchmark | 6/1/17 – 5/31/18 | Less than or equal to the current national benchmark SIR. CMS reserves the right to change the SIR as the national benchmark changes during the contract period. | 5/1/18 – 10/31/18 |
| Task C.1, Section B; & Task C.1.4.2.1 | D = The number of predicted CLABSI cases. |
| C.1-2 CAUTI Standardized Infection Ratio (SIR) | The number of CAUTI cases in a facility over the predicted number of CAUTI cases for that facility over a specified amount of time. | N = The number of CAUTI cases for a participating provider. | Targeted facility and NHSN | N/A | SIR of more than or equal to 60% of the national benchmark | 8/1/14 – 5/31/15 | SIR of more than or equal to 70% of the national benchmark | 6/1/15 – 5/31/16 | SIR of more than or equal to 80% of the national benchmark | -6/1/16 – 5/31/17 | SIR of more than or equal to 90% of the national benchmark | -6/1/17 – 5/31/18 | Less than or equal to the current national CAUTI SIR benchmark. CMS reserves the right to change the SIR as the national benchmark changes during the contract period. | 5/1/18 – 10/31/18 |
| Task C.1, Section B; &Task C.1.4.2.2 | D = The number of predicted CAUTI cases |
| C.1-3 Urinary Catheter Utilization Rate | Number of urinary catheter days per number of patient days per each individual patient care location/unit that is chosen for monitoring. | N = The number of urinary catheter days per monitored patient care location/unit for a participating provider. | NHSN | N/A | For at least 50% of the patient care units chosen for monitoring, achieve a DUR that is less than the most current posted national ratio for each specific CDC patient care location type. | 8/1/14 – 5/31/15 | For at least 60% of the patient care units chosen for monitoring, achieve a DUR that is less than the most current posted national ratio for each specific CDC patient care location type. | 6/1/15 – 5/31/16 | For at least 70% of the patient care units chosen for monitoring, achieve a DUR that is less than the most current posted national ratio for each specific CDC patient care location type. | 6/1/16 – 5/31/17 | For at least 80% of the patient care units chosen for monitoring, achieve a DUR that is less than the most current posted national ratio for each specific CDC patient care location type. | 6/1/17 – 5/31/18 | For at least 80% of the patient care units chosen for monitoring, achieve a DUR that is less than the most current posted national ratio for each specific CDC patient care location type. | 5/1/18 – 10/31/18 |
| Task C.1, Section B; &Task C.1.4.2.2 | D = The number of patient days per monitored patient care location/unit for the same participating provider. |
| C.1-4 CDI Standardized Infection Rate (SIR) | The reduction in the SIR of CDI for a targeted facility compared to the baseline CDI SIR in that same facility. | N = The number of observed CDI cases for a participating provider. | NHSN | N/A | SIR of more than or equal to 60% of the national benchmark | 8/1/14 – 5/31/15 | SIR of more than or equal to 70% of the national benchmark | 6/1/15 – 5/31/16 | SIR of more than or equal to 80% of the national benchmark | -6/1/16 – 5/31/17 | . SIR of more than or equal to 90% of the national benchmark | 6/1/17 – 5/31/18 | Less than or equal to the current CDI SIR national benchmark SIR. CMS reserves the right to change the SIR as the national benchmark changes during the contract period. | 5/1/18 – 10/31/18 |
| Task C.1, Section B; &Task C.1.2.3 | D = The Number of predicted CDI cases. |
| C.1-5 Recruitment | QIO recruitment of non-ICU and ICU units in acute care facilities to participate in HAI projects. | Non-ICU and ICU units will be recruited that meet the criteria regarding the HAI definitions listed above. | NHSN | N/A | 100% recruitment | 8/1/14 – 5/31/15 | N/A | N/A | N/A | N/A | N/A | N/A | 100% by 7/31/15 | 8/1/14 – 5/31/15 |
| Task C.1, Section B; &Task C.1.2 |
Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
* N=Numerator D= Denominator
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
The most favorable results of either relative improvement (using the baseline) or absolute improvement (not using the baseline) will be used.
Task C.2.
| TASK C.2 – REDUCING HEALTHCARE-ACQUIRED CONDITIONS IN NURSING HOME: Each of the following minimum performance criteria contained in Task C.2 must be met for each state or territory in the service area. | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| C.2-1 Antipsychotic Medication Use | Rate of reduction in percentage of residents who received antipsychotic medications. | N = all long-stay residents with a selected target assessment indicating that an antipsychotic medication was received within the last 7 days (or since admission/re-entry if the admit was less than 7 days ago) | MDS 3.0/ QIES Workbench | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD |
| Task C.2, Sections B & F; & Task C.2.7. | D = all long-stay residents with a selected target assessment and the MDS field capturing the antipsychotic med information is not missing (MDS item N0400A prior to 3/31/12 or MDS item N0410A after 3/31/12) OR if the resident shows a diagnosis of Schizophrenia, Tourette’s Syndrome, or Huntington’s Disease on the MDS assessment. |
| C.2-2 Rate of Mobility | Percentage of long-stay residents with improved mobility | N = TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD |
| Task C.2, Sections B & F; & Task C.2.7. | D = TBD |
| C.2-3 Recruitment of One-Star Nursing Homes (Star Category Target Number [SCTN] for Collaborative I) | Percentage of One-Star Category Target Number recruited for Collaborative I. | N= Number of One-Star Nursing Homes Recruited by State by 3/31/15. | See Appendix 2: Calculation of Nursing Home Recruitment Target Number and Star Category Target Count. | N/A | >35% of 1-Star Category Target Number by 3/31/15 | 10/1/14 through 3/31/15 | N/A | N/A | NA | NA | N/A | N/A | NA | NA |
| Task C.2, Sections B & F; & Task C.2.7. | D = Multiply the number provided in the One-Star column of the Nursing Home Provider Ratings Table by 75%. | |||||||||||||
| CMS will apply the Integer Rounding Rule |
| C.2-4 Recruitment of One-Star Nursing Homes (Star Category Target Number for Collaboratives I and II) | Sum of Percentages of One-Star Category Target Number recruited for Collaboratives I and II. | N= Number of One-Star Nursing Homes Recruited by State by 3/31/15 and 3/31/17 with unique CCNs. | See Appendix 2: Calculation of Nursing Home Recruitment Target Number and Star Category Target Count. | N/A | >35% of 1-Star Category Target Number by 3/31/15 | 10/1/14 through 3/31/15 | N/A | N/A | >65% of 1-Star Category Target Number by 3/31/17 | 10/1/16 through 3/31/17 | N/A | N/A | >100% of One-Star Category Target Count | 10/1/2014 through 3/31/2015 plus 10/1/2016 through 3/31/2017 |
| Task C.2, Sections B & F; & Task C.2.7. | D = Multiply the number provided in the One-Star column of the Nursing Home Provider Ratings Table by 75%. | |||||||||||||
| CMS will apply the Integer Rounding Rule |
| C.2-5 Recruitment Target Number (RTN) for Collaborative I | Percentage of Recruitment Target Number recruited for Collaborative I | N= Number of Nursing Homes with unique CCNs Recruited by State by 3/31/2015. | See Appendix 2: Calculation of Nursing Home Recruitment Target Number and Star Category Target Count. | N/A | >35% of RTN by 3/31/15 | 10/1/14 through 3/31/15 | NA | NA | NA | NA | NA | NA | NA | NA |
| Task C.2, Sections B & F; & Tasks C.2.2. & C.2.7. | D = Calculation of Recruitment Target Number as provided in C.2, Appendix 2 | |||||||||||||
| CMS will apply the Integer Rounding Rule |
| C.2-6 Recruitment Target Number (RTN) for Collaborative I and II | Sum of percentages of Recruitment Target Number recruited for Collaboratives I and II. | N= Number of Nursing Homes with unique CCNs Recruited by State by 3/31/2015 and 3/31/17. | See Appendix 2: Calculation of Nursing Home Recruitment Target Number and Star Category Target Count. | N/A | >35% of RTN by 3/31/15 | 10/1/14 through 03/31/15 | NA | NA | >65% of RTN by 3/31/17 | 10/1/16 through 3/31/17 | NA | NA | >100% of RTN | 10/1/2014 through 3/31/2015 plus 10/1/2016 through 3/31/2017 |
| Task C.2, Sections B & F; & Tasks C.2.2. & C.2.7. | D = Calculation of Recruitment Target Number as provided in C.2, Appendix 2 | |||||||||||||
| CMS will apply the Integer Rounding Rule |
| Task C.2-7 Quality Composite Measure Score | NNHQCC Quality Composite Measure Score | N = Summing the numerators of the 13 NQF-endorsed, long-stay Quality Measures* | MDS 3.0/ QIES Workbench* | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD |
| Task C.2, Sections B & F; & Task C.2.7. | D = Summing the denominators of the 13 NQF-endorsed, long-stay Quality Measures.* | |||||||||||||
| *(See Attachment J.1, Task C.2.Appendix 4) | *Provided monthly to QIOs |
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
Task C.3.
| TASK C.3 – COORDINATION OF CARE | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| C.3-1 Interventions Implemented | Percentage of interventions implemented (for a minimum of 6 months) that show improvement (for a minimum of 5 interventions across the region annually). | N = Number of interventions implemented for a minimum of 6 months that show improvement. | QIO | N/A | N/A | 8/1/14 through 7/31/15 | 40% | 8/1/15 through 7/31/16 | 60% | 8/1/16 through 7/31/17 | 60% | 8/1/17 through 7/31/18 | 60% | 11/01/2017 through 10/31/2018 |
| Task C.3., Sections B & G; & Tasks C.3.3. | D = Number of interventions measured during annual time period. |
| Baseline time period and remeasurement criteria for the following measure is for community cohorts recruited through December 31, 2014. For rolling recruitment: (a) Community cohorts will be defined by the calendar year of recruitment (January 1-December 31) with each cohort baseline beginning in the prior year (August 1- July 31), and (b) minimum performance criteria for each cohort of recruited communities will be 2% (August 1- July 31) of the year following the recruitment year, 6% for year two and 10% for subsequent years, and (c) the minimum performance criteria will be based on a weighted (by size of community baseline denominators) criteria for recruited communities. | ||||||||||||||
| C.3-2 30-day Readmissions | Percentage of 30-day readmissions per 1,000 FFS beneficiaries in region-wide coalition. | N = The number of readmissions within 30 days of a hospital discharge | Claims | 08/01/2013 through 7/31/14 | N/A | 8/1/14 through 7/31/15 | 2% Relative Improvement Rate (RIR) | 8/1/15 through 7/31/16 | 6% RIR | 8/1/16 through 7/31/17 | 10% RIR | 8/1/17 through 7/31/18 | 10% RIR | 08/01/2017 through 07/31/2018 |
| Task C.3., Sections B & G; & Task C.3.7. | D = The number of FFS beneficiaries at risk for hospitalization residing in the ZIP codes associated with the QIO region-wide coalition. |
| Baseline time period and remeasurement criteria for the following measure is for community cohorts recruited through December 31, 2014. For rolling recruitment: (a) Community cohorts will be defined by the calendar year of recruitment (January 1-December 31) with each cohort baseline beginning in the prior year (August 1- July 31), and (b) minimum performance criteria for each cohort of recruited communities will be 2% (August 1- July 31) of the year following the recruitment year, 6% for year two and 10% for subsequent years, and (c) the minimum performance criteria will be based on a weighted (by size of community baseline denominators) criteria for recruited communities. | ||||||||||||||
| C.3-3 Admissions | Percentage of admissions per 1,000 FFS beneficiaries in region-wide coalition. | N = The total number of admissions. | Claims | 08/01/2013 through 7/31/14 | N/A | 8/1/14 through 7/31/15 | 1.4% RIR | 8/1/15 through 7/31/16 | 4.2% RIR | 8/1/16 through 7/31/17 | 7% RIR | 8/1/17 through 7/31/18 | 7% RIR | 08/01/2017 through 07/31/2018 |
| Task C.3., Sections B & G; & Task C.3.7 | D = FFS beneficiaries at risk for hospitalization reside in the zip codes associated with the region-wide coalition. |
| C.3-4 Region-wide Readmissions | Percentage of region-wide readmissions per 1,000 FFS beneficiaries. | N = The total number of readmissions within 30 days of discharge. | Claims | 08/01/2013 through 7/31/14 | N/A | 8/1/14 through 7/31/15 | 0.4% RIR | 8/1/15 through 7/31/16 | 1.2% RIR | 8/1/16 through 7/31/17 | 2% RIR | 8/1/17 through 7/31/18 | 2% RIR | 08/01/2017 through 07/31/2018 |
| Task C.3., Sections B & G; & Task C.3.7 | D = The number of FFS beneficiaries at risk for hospitalization residing in the QIO service area X 1,000. |
| C.3-5 Region-wide Admissions | Percentage of region-wide admissions per 1,000 FFS beneficiaries. | N = The total number of admissions. | Claims | 08/01/2013 through 7/31/14 | N/A | 8/1/14 through 7/31/15 | 0.4% RIR | 8/1/15 through 7/31/16 | 1.2% RIR | 8/1/16 through 7/31/17 | 2% RIR | 8/1/17 through 7/31/18 | 2% RIR | 08/01/2017 through 07/31/2018 |
| Task C.3., Sections B & G; & Task C.3.7 | D = The number of FFS beneficiaries at risk for hospitalization residing in the QIO service area X 1,000. |
| C.3-6 Region-wide Reduction in Adverse Drug Events | Percentage of adverse drug events per 1,000 screened beneficiaries. | N = Total number of adverse drug events reported in the region. | QIO | 08/01/2013 through 7/31/14 | N/A | 8/1/14 through 7/31/15 | 10% RIR | 8/1/15 through 7/31/16 | 35% RIR | 8/1/16 through 7/31/17 | 50% RIR | 8/1/17 through 7/31/18 | 50% RIR | 08/01/2017 through 07/31/2018 |
| Task C.3., Sections B & G; & Task C.3.5 | D = Total number of beneficiaries in the region screened for adverse drug events X 1,000. . |
| C.3-7 Community Tenure | Increased community tenure in region-wide coalition. “Community tenure” is defined as the number of days beneficiaries spend in their home setting. | N = total number days of all beneficiaries residing at home/in the community across all community coalitions. | Claims | 08/01/2013 through 7/31/14 | N/A | 8/1/14 through 7/31/15 | TBD | 8/1/15 through 7/31/16 | TBD | 8/1/16 through 7/31/17 | TBD | 8/1/17 through 7/31/18 | TBD | 08/01/2017 through 07/31/2018 |
| Task C.3., Sections B & G; & Task C.3.2 | D = number of Medicare FFS beneficiaries living in the region-wide coalition. |
Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
Task D.1.
| TASK D.1 – QUALITY IMPROVEMENT THROUGH PHYSICIAN VALUE-BASED MODIFIERS | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| D.1-1-Learning Forums | Percentage of eligible physicians/ physician groups attending QIO-convened forums related to the Value Modifier (VM) Program | N = Number of eligible physicians/ physician groups that attend QIO-convened forums related to VM. | QIO | N/A | 35% | 8/1/14 through 7/31/15 | 55% | 8/1/14 through 7/31/16 | 75% | 8/1/14 through 7/31/17 | 85% | 8/1/14 through 7/31/18 | 90% | 08/01/2014 through 1/31/19 |
| Sections B & D; and Tasks D.1.6. & D.1.7 | D = Total number of eligible physicians/ physician groups participating in VM. |
| D.1-2 Quality Improvement/QRUR | Percentage of eligible physicians/ physician groups that demonstrate improvement in quality-of-care measures (per QRUR) after receiving TA from QIOs. | N= Number of eligible physicians/ physician groups that demonstrate improvement (per QRUR). | QIO | N/A | 50% | 8/1/14 through 7/31/15 | 60% | 8/1/14 through 7/31/16 | 75% | 8/1/14 through 7/31/17 | 85% | 8/1/14 through 7/31/18 | 90% | 08/01/2014 through 1/31/19 |
| Sections B & D; and Tasks D.1.5., & D.1.7., | D = total number of eligible physicians/ physician groups receiving TA from QIOs based on QRUR reports. | |||||||||||||
| D.1-2 Quality Improvement ASC | Percentage of eligible ASC's that demonstrate improvement in quality-of-care measures (per ASCQR) after receiving TA from QIOs. | N=Number of eligible ASC's that demonstrate improvement on at least one measure targeted at recruitment | CMS | N/A | 10% | 12/1/14 through 7/31/15 | 15% | 8/1/14 through 7/31/16 | 15% | 8/1/14 through 7/31/17 | 15% | 8/1/14 through 7/31/18 | 15% | 12/01/2014 through 1/31/19 |
| D = Total number of eligible ASC's included in most recent ASCQR payment determination | ||||||||||||||
| D.1-2 Quality Improvement IPF | Percentage of eligible IPF's that demonstrate improvement in quality-of-care measures (per IPFQR) after receiving TA from QIOs. | N=Number of eligible IPF's that demonstrate improvement on at least one measure targeted at recruitment | CMS | N/A | 10% | 12/1/14 through 7/31/15 | 15% | 8/1/14 through 7/31/16 | 15% | 8/1/14 through 7/31/17 | 15% | 8/1/14 through 7/31/18 | 15% | 12/01/2014 through 1/31/19 |
| D = Total number of eligible IPF's included in most recent IPF payment determination | ||||||||||||||
| D.1-2 Quality Improvement CAH | Percentage of eligible CAH's that demonstrate improvement in quality-of-care measures (per IQR or OQR) after receiving TA from QIOs. | N=Number of eligible CAH's that demonstrate improvement on at least one IQR or OQR measure targeted at recruitment | CMS | N/A | 15% | 81/14 through 7/31/15 | 15% | 8/1/14 through 7/31/16 | 15% | 8/1/14 through 7/31/17 | 15% | 8/1/14 through 7/31/18 | 15% | 12/01/2014 through 1/31/19 |
| D = Total number of open CAH's included in CASPER as of annual recruitment deadline | ||||||||||||||
| D.1-2 Quality Improvement PPS-Exempt Cancer Hospital (PCH) | Percentage of eligible PCH's that demonstrate improvement in quality-of-care measures (per PCHQR) after receiving TA from QIOs. | N=Number of eligible PCH's that demonstrate improvement on at least one PCHQR measure targeted at recruitment | CMS | N/A | 50% | 81/14 through 7/31/15 | 50% | 8/1/14 through 7/31/16 | 50% | 8/1/14 through 7/31/17 | 50% | 8/1/14 through 7/31/18 | 50% | 12/01/2014 through 1/31/19 |
| D = Total number of open PCH's included in CASPER as of annual recruitment deadline | ||||||||||||||
| D.1-2 Quality Improvement Hospital Outpatient Department | performance period median national measure rate on OQR measure as posted on Hospital Compare. | (Performance period national performance rate divided by baseline period (2013 calendar year encounters) national median OQR rate posted on Hospital Compare) minus 1. NOTE: timing measures and adverse outcomes will be converted to measure improvement in terms of reducing timing and adverse outcomes | CMS | N/A | 13% | 10/1/14 through 9/30/15 encounters | 25% | 10/1/15 through 9/30/16 encounters | 38% | 10/1/16 through 9/30/17 encounters | 50% | 10/1/17 through 9/30/18 encounters | ||
| D.1-2 Quality Improvement Hospital VBP Inpatient Department | performance period median national measure rate on HIQR and HVBP measure as posted on Hospital Compare. | (Performance period national performance rate divided by baseline period (2013 calendar year encounters) national median HVBP rate posted on Federal Register) minus 1. NOTE: adverse outcomes will be converted to measure improvement in terms of survivability and improving outcomes | CMS | N/A | 16% | 1/1/15 through 12/31/15 discharges | 33% | 1/1/16 through 12/31/16 discharges | 50% | 1/1/16 through 12/31/17 discharges |
| D.1-3 Quality Improvement/Technical Assistance for PQRS | Percentage of eligible physicians/ physician groups actively participating in VM that require technical assistance for electronic submission (PQRS) and are successful in subsequent submissions. | N = The number of eligible physicians/ physician groups requiring technical assistance in use of PQRS for VM Program and are subsequently successful in submissions in QIO-designated service area. | QIO | N/A | 50% | 8/1/14 through 7/31/15 | 60% | 8/1/14 through 7/31/16 | 75% | 8/1/14 through 7/31/17 | 85% | 8/1/14 through 7/31/18 | 90% | 08/01/2014 through 1/31/19 |
| Sections B & D; and Task D.1.7. | D = Total number of eligible physicians/ physician groups within QIO-designated service area that require TA in use of PQRS for VM Program. |
| D.1-4 Physician/Physician Group Participation | Percentage of eligible physicians/eligible physician groups receiving payment adjustments through VM. | N = The number of eligible physicians/ physician groups receiving payment adjustments through VM w/ in QIO-designated area. | QIO/CMS | N/A | 50% | 8/1/15 through 7/31/15 | 60% | 8/1/15 through 7/31/16 | 65% | 8/1/15 through 7/31/17 | 70% | 8/1/17 through 7/31/18 | 75% | 08/01/2014 through 1/31/19 |
| Sections B&D; and Tasks D.1.2., D.1.6., and D.1.7. | D= Total number of eligible physicians/physician groups w/in QIO-designated area. |
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
Physicians who receive a VBM payment adjustment for failure to report PQRS data shall be excluded from the numerator.
Physicians who receive a VBM payment adjustment for failure to report PQRS data shall be excluded from the numerator.
Physicians who receive a VBM payment adjustment for failure to report PQRS data shall be excluded from the numerator.
Physicians who receive a VBM payment adjustment for failure to report PQRS data shall be excluded from the numerator.
Task D.2.
(NOTE: These measures and target criteria will be determined individually per project.)
| TASK D.2 – QIO-PROPOSED PROJECTS THAT ADVANCE BETTER HEALTH AND LOWER COST | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
Measure # & Name followed by Corresponding Task Order 001 Reference Measure Definition N/D * Apply percentage rounding rule, unless indicated Source Time Period Criteria Time Period Criteria Time Period Criteria Time Period Criteria Time Period Criteria Time Period
Task E.1
| TASK E.1 – TECHNICAL ASSISTANCE – QUALITY IMPROVEMENT INTIATIVES (QIIs) | ||||||
| TABLE 1 - MEASURE DEFINITIONS AND SPECIFICATIONS | EVALUATION CRITERIA AND TIME PERIODS | |||||
| Baseline | Jul-15 | Jul-16 | Jul-17 | Jul-18 | Jan-19 |
| Measure # & Name followed by Corresponding Task Order 001 Reference | Measure | Definition N/D * Apply percentage rounding rule, unless indicated | Source | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period | Criteria | Time Period |
| E.1-1 Timeliness of QII | Percentage of QIIs initiated within 30 days of the receipt of a referral or a request for QII technical assistance. | N = The number of QIIs initiated within 30 days of the receipt of a referral or a request for QII technical assistance. | QIO | N/A | 80% | 8/1/14 through 7/31/15 | 80% | 8/1/15 through 7/31/16 | 85% | 8/1/16 through 7/31/17 | 90% | 8/1/17 through 7/31/18 | 90% | 08/01/2017 through 12/31/18 |
| Task E.1, Section B; & Tasks E.1.1 and E.1.2. | D = The total number of QII referrals and requests. |
| E.1-2 Rate of Successful QIIs | Percentage of QIIs successfully resolved. | N = The number of successful QIIs. | QIO | N/A | 70% | 8/1/14 through 7/31/15 | 70% | 8/1/15 through 7/31/16 | 75% | 8/1/16 through 7/31/17 | 80% | 8/1/17 through 7/31/18 | 80% | 08/01/2017 through 12/31/18 |
| Task E.1, Section B; & Tasks E.1.1 and E.1.2. | Definition of successful QII TBD. | D = The total number of QIIs. |
Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
&"Arial,Regular"&14QIN-QIO 11th SOW Task Order 001, Attachment B Evaluation Measures Table
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