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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 002 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 | 60% | 8/1/17 through 7/31/18 | 80% | 02/01/2015 through 12/31/18 |
| B.1.2.2, B.1.5.2, B.1.5.3 | (CEHRT 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 | 90% | 02/01/2015 through 12/31/18 |
| B.1.2.2, B.1.5.2 | (CEHRT 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 | 90% | 02/01/2015 through 12/31/18 |
| B.1.2.2, B.1.5.2 | (CEHRT 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
* 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.
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 002 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
* N=Numerator D= Denominator
Task B.3.
| TASK B.3. – USING IMMUNIZATION INFORMATION SYSTEMS | | | | | | |
| 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 002 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
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 002 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 communities using CEHRT receiving technical assistance | 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 practitioners/providers receiving technical assistance | N = Number of recruited practitioners/providers receiving technical assistance | 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 practitioners/providers receiving TA | | | | | | | | | | | | |
| 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 providers/practitioners attending QIO’s educational sessions (as outlined in task 1) | 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 signed participants (including those without CEHRT) | | | | | | | | | | | | |
| B.4-4 Quality Improvement and HIT Advancement (Improved Outcomes) | Percentage of recruited practitioners/providers that receive TA that meet EHR Incentive Program quality reporting requirements post TA | N = Number of recruited providers/practitioners who received TA and have met EHR Incentive Program quality reporting requirements | 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 practitioners/providers that established an electronic connection with beneficiaries/family representative | QIO Collected | N/A | 10% | August 1, 2014 -July 31, 2015 | 30% | August 1, 2014-July 31, 2016 | 40% | August 1, 2014-July 31,2017 | 60% | August 1, 2014-July 31, 2018 | 60% | August 1, 2014 –December 31, 2018 |
| Task B.4, Section B; & Task B.4.6 | | D = Total number of recruited practitioners/providers using CEHRT | | | | | | | | | | | | |
&"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 002 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
* 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.
Task C.2.
| TASK C.2 – REDUCING HEALTHCARE-ACQUIRED CONDITIONS IN NURSING HOME: Each of the following minimum performance criteria containined 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 002 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 | 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) | CASPER | TBD | 2% | 1/1/15 through 3/31/15 | 3% | 4/1/15 through 3/31/16 | 9% | 4/1/16 through 3/30/17 | 15% | 4/1/17 through 3/31/18 | >15% | 4/1/18 through 3/31/19 |
| 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 3/31/2015 | 10/1/14 through 03/31/2015 | 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%. | | | | | | | | | | | | |
| 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. | 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 3/31/2015 | 10/1/2014 through 03/31/2015 | N/A | N/A | >65% of 1-Star Category Target Number by 3/31/17 | 10/31/14 through 3/31/17 | N/A | N/A | >100% of One-Star Category Target Count | 10/01/2014 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%. | | | | | | | | | | | | |
| 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 3/31/1205 | 10/1/2014 through 03/31/2015 | 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 Interger 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 3/31/1205 | 10/1/2014 through 03/31/2015 | NA | NA | >65% of RTN by 3/31/17 | 10/31/14 through 3/31/17 | NA | NA | >100% of RTN | 10/01/2014 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 Interger Rounding Rule | | | | | | | | | | | | |
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 002 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. | | | | | | | | | | | | |
| 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% | 8/1/15 through 7/31/16 | 6% | 8/1/16 through 7/31/17 | 10% | 8/1/17 through 7/31/18 | 10% | 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. | | | | | | | | | | | | |
| 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% | 8/1/15 through 7/31/16 | 4.2% | 8/1/16 through 7/31/17 | 7% | 8/1/17 through 7/31/18 | 7% | 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% | 8/1/15 through 7/31/16 | 1.2% | 8/1/16 through 7/31/17 | 2% | 8/1/17 through 7/31/18 | 2% | 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% | 8/1/15 through 7/31/16 | 1.2% | 8/1/16 through 7/31/17 | 2% | 8/1/17 through 7/31/18 | 2% | 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% Reduction from baseline. | 8/1/15 through 7/31/16 | 15% Reduction from baseline | 8/1/16 through 7/31/17 | 35% Reduction from baseline | 8/1/17 through 7/31/18 | 50% Reduced from baseline | 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. | | | | | | | | | | | | |
| 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
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 002 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.1-3 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
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 #____ 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 002 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
