ACOs Moving Ahead

By Sean Cavanaugh, Deputy Administrator and Director, Center for Medicare

Today, we at CMS are excited to announce that 89 new Accountable Care Organizations (ACOs) will be joining the Medicare Shared Savings Program (Shared Savings Program). With today’s announcement, we will have a total of 405 ACOs participating in the Shared Savings Program next year, serving more than 7.2 million beneficiaries. When combined with the Innovation Center’s 19 Pioneer ACOs, we will have a total of 424 ACOs serving over 7.8 million beneficiaries.    

ACOs are one part of this Administration’s vision for improving the coordination and integration of care received by Medicare beneficiaries. ACOs are groups of doctors, hospitals, and other health care providers that work together to give Medicare beneficiaries in Original Medicare (fee-for-service) high quality, coordinated care. ACOs can share in any savings they generate for Medicare, if they meet specified quality targets.

Since ACOs first began participating in the program in early 2012, thousands of health care providers have signed on to participate in the program, working together to provide better care to Medicare’s seniors and people with disabilities. In 2014 alone, existing Shared Savings Program ACOs added almost 17,000 healthcare providers, and the 89 new ACOs will bring approximately 23,000 additional physicians and other providers into the ACO program starting January 1. The growth of this program for providing health care has been continued and consistent since its inception, and we are encouraged by that interest.

We are starting to see promising results. This fall, we released the early findings from the ACOs who started the program in 2012. Shared Savings Program ACOs improved on 30 of the 33 quality measures in the first 2 years, including patients’ ratings of clinicians’ communication, beneficiaries’ rating of their doctors, and screening for high blood pressure. They also outperformed group practices reporting quality on 17 out of 22 measures. We are also seeing promising results on cost savings with combined total program savings of $417 million for the Shared Savings Program and the Pioneer ACO Model.

While we are encouraged by what we have seen so far, we also understand there are opportunities to improve the program to make it stronger. Earlier this month, we published a proposed rule to update the guidelines for the program. We are looking forward to receiving comments from ACOs, beneficiaries, and their advocates, providers, and other stakeholders interested in seeing the ACOs succeed long-term.

ACOs are also just one way that CMS is working to reduce the rate of growth in Medicare spending while improving care. Medicare spending per beneficiary was essentially flat in nominal dollars in fiscal year 2014, and from 2010 to 2014, Medicare spending per beneficiary grew at a rate that was 2 percentage points per year less than growth in GDP per capita. While the recent slow cost growth has multiple causes, our reforms in the Medicare and Medicaid programs are meaningful contributors to these gains and are improving quality as well. Preliminary data for 2013, for example, indicates improvements in patient safety resulted in 50,000 fewer deaths, 1.3 million fewer patient harms, and $12 billion in avoided health care spending. Recent research implies that many of these reforms may be generating savings in the private sector as well.

Ultimately, today’s announcement is about delivering better care, spending dollars more wisely, and having healthier people and communities. ACOs drive progress in the way care is provided by improving the coordination and integration of health care, and improving the health of patients with a priority placed on prevention and wellness. We look forward to continuing this partnership with doctors, hospitals, and other health care providers in increasing value and care coordination across the health system.

For a list of the 89 new ACOs announced today, visit: ?


CMS releases data on quality to help patients choose providers

Updates provide quality metrics for hospitals and physicians
By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

The Centers for Medicare & Medicaid Services (CMS) today released data on the quality of care provided by physician group practices, Accountable Care Organizations (ACOs) and hospitals. These data are available on Physician Compare, Hospital Compare and

The performance information released this month will give patients and families additional information they can use to inform their selection of a hospital or physician practice. Health care professionals differ in the quality and safety of care they provide and these websites empower consumers with information to help with health care decisions, encourage providers to strive for higher levels of quality, and drive overall health system improvement.

The data released today includes:

  • Information on Hospital Value-Based Purchasing Program 2015 payment adjustments The Hospital Value-Based Purchasing Program provides a useful snapshot of how hospitals are performing on important quality indicators of patient care, quality, efficiency, and well-being. It is one of many Affordable Care Act programs Medicare is implementing to pay for quality instead of quantity. The program ties a portion of payments to hospitals’ performance on certain quality measures such as death within 30 days after a heart attack and patient experience of care.
    The portion of FY 2015 Medicare payments available to fund the value-based incentive payments increases from 1.25 to 1.5 percent of the base operating DRG payment amounts to all participating hospitals. The total amount available for value-based incentive payments in FY 2015 will be approximately $1.4 billion.

    Data from the third year of the program indicates that hospitals are improving care and outcomes for Medicare beneficiaries. More hospitals this year will experience a positive change in their payments (1,714) compared to the number of hospitals that will experience a negative change (1,375) – a reversal of last year  This change indicates that many hospitals are improving the quality of care delivered to patients.
    More information on the Hospital Value-Based Purchasing program payment adjustments can be found here:

  • Updated performance results on diabetes and cardiovascular care by some physician group practices and ACOs

    CMS has posted the publicly reported 2013 Physician Quality Reporting System (PQRS) Group Practice Reporting Option measures for the 139 group practices and 214 Shared Savings Program Accountable Care Organizations (ACOs) and 23 Pioneer ACOs.

  • Hospital performance results on Hospital-Acquired Conditions (HACs) such as central line-associated bloodstream infections, catheter associated urinary tract infections, pressure ulcers and accidental punctures or lacerations
    HACs are a group of reasonably preventable conditions that patients did not have upon admission to a hospital, but developed during the hospital stay. The HAC Reduction Program uses public reporting and financial incentives to encourage hospitals that treat Medicare beneficiaries to reduce HACs and improve patient safety.
    To determine hospital performance under the HAC Reduction Program, CMS computes a Total HAC Score for each hospital. The higher a hospital’s Total HAC Score, the less well the hospital performed under the HAC Reduction Program. Beginning in FY 2015, the law requires a payment reduction of one percent for those hospitals that rank in the top quartile of Total HAC Scores.
    More information on the HACs Reduction program and HAC scores can be found here:

CMS is committed to providing useful and current quality performance data. The Compare sites empower consumers with information to help with health care decisions, encourage providers to strive for higher levels of quality, and drive overall health system improvement. While consumers and patients are the main audience for the Compare sites, stakeholders can visit and use the same data that power the Compare websites in easy-to-use formats.
CMS is committed to transparency of data about quality and cost of care provided by physicians, hospitals and other health care professionals. This transparency is critical to transforming the health care delivery system to achieve the three aims of better care for patients, better health for communities and spending dollars wisely.


Home Health Compare Site to Offer New Tools for Consumers

By Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer

Consumers have many options when choosing a health care provider. Providers vary in the quality of the care they give, and everyone wants to choose the provider who will be best for themselves or their loved ones. Yet frequently the choice must be made quickly and without the time for consumers to locate and review a wide range of information sources.

The Centers for Medicare & Medicaid Services (CMS) has established the Compare sites on as the official CMS source for information about the quality of health care providers so that consumers have a single, easy-to-access source of information to support their decision-making.

Yet sometimes even the information on the Compare sites can seem like “too much of a good thing” – too much information, too many measures to consider. Therefore, CMS has been adding new tools to the Compare sites in order to make the information there easier to use.  These include “star” ratings, similar to the ratings that consumers can review on websites for other products and services, which summarize the detailed information on health care provider quality that the sites already offer and make it more accessible to consumers.

We plan to add star ratings to Home Health Compare as early as the summer of 2015. None of the current information on the site will be removed; rather, the star ratings are intended to be an additional tool to support consumers’ health care decision-making. Over the coming months, we will be sharing the details of our proposed method for calculating the star ratings and soliciting input from consumers, home health providers, and other stakeholders, so that we can make the Home Health Compare star ratings as reliable and useful as possible.

We are excited to be expanding our support for home health care consumers, and we hope that the data will lead to continuing improvement in the quality and efficiency of the services that are provided to our beneficiaries.

New Open Payments Search Tool Launches Today: Access a simple to use search interface

By Dr. Shantanu Agrawal, CMS Deputy Administrator and Director of Center for Program Integrity

Open Payments is a congressionally mandated, national disclosure program that promotes transparency and accountability in health care. But what does “transparency” mean to you as a patient, and why is it important? The program gives you the opportunity to know if your doctors have a financial relationship with companies that make or supply medications, medical supplies or devices, and the biological products used in your care. The bottom line is that knowing about these relationships will let you be a more involved and informed health care consumer.

On September 30, 2014, we posted the first set of data about these financial relationships at To make it easier to search the Open Payments data, we’ve released a beta search tool that allows you to search your doctor by name. As we work to make searching easier, we are asking for your feedback to improve website. Additional enhancements will be made available in coming weeks, including displays of summary data, data charts, graphs, as well as more detailed data. These innovative improvements will add value to both consumers and researchers using the Open Payments data.

With the addition of this new search tool, we are also providing more detailed information on the data released, including updating the data about the company that made the payment, giving researchers and consumers more granular information. This update was made in the “Applicable Manufacturer or Applicable GPO Making Payment Name” column and will provide the company that provided the payment.

Please visit to view the data and use the new search tool, and take the next step in becoming a more involved and informed health care consumer.



By Marilyn Tavenner, CMS Administrator

As we approach the beginning of Medicare open enrollment on October 15, the Centers for Medicare & Medicaid Services (CMS) wants everyone to know that for most seniors who have Original Medicare, the 2015 Part B premiums will remain unchanged for a second consecutive year. This means more of seniors’ retirement income—and any increase in Social Security benefits—stays in their pockets.

In addition, quality continues to improve both in Medicare Advantage and the Part D Prescription Drug Program, as more people with Medicare get access to higher quality plans. About 60 percent of people who have a Medicare Advantage Plan are currently enrolled in plans with four or more stars for 2015, compared to an estimated 17 percent back in 2009 (Medicare Advantage enrollment is projected to reach an all-time high in 2015, with more than 16 million beneficiaries). Likewise, about 53 percent of Part D enrollees are currently enrolled in stand-alone prescription drug plans with four or more stars for 2015, compared to just 16 percent in 2009.

CMS calculates plan star ratings for Medicare health and drug plans on a scale of 1 to 5—with 5 being the best—based on quality and performance. These ratings are designed to help beneficiaries, their families, and caregivers compare plans. Overall, the number of Medicare Advantage Plans and prescription drug plans earning four or more stars for 2015 increased by 6 and 36 percent, respectively, compared with 2014.

Improved quality in Medicare health and prescription drug plans is just one of the many positive changes we’ve seen since the Affordable Care Act was signed into law.

Thanks to slower than expected growth in health care, premiums and deductibles in 2015 for the approximately 49 million Americans enrolled in Original Medicare will remain unchanged at $104.90 and $147, respectively. For the fourth year in a row, Medicare premium costs are meeting or beating expectations. According to Health & Human Services, premiums will be at least $125 lower over the course of a year then what the Congressional Budget Office (CBO) estimated for 2015 back in 2009.

This news comes as historically slow growth in health care costs continues. Health care prices are rising at their lowest rates in nearly 50 years, Medicare spending per beneficiary is currently falling, and—according to a major annual survey released last month—employer premiums for family coverage grew just 3.0 percent in 2014, tied with 2010 for the lowest percentage increase on record back to 1999.

We’re continuing to work hard to make sure this good news continues. The lower costs and better care is good news for the Trust Funds, great news for taxpayers, and even better news for people with Medicare.

CMS announces first report on provider performance from a Qualified Entity

Niall Brennan, Acting Director, CMS Offices for Enterprise Management

Data can play an integral role in helping consumers decide on everything from which car to drive to choosing a hotel. Indeed, data-driven decision support tools are available in almost every sector. Though many tools are available in health care, the sector as a whole has lagged behind others in providing data on health care quality and cost.

Today, we are excited to announce the first public report on provider performance and cost facilitated by the Medicare Data Sharing for Performance Measurement Program, known as the Qualified Entity Program. The Qualified Entity Program allows organizations that are certified as qualified entities (QEs) to combine Medicare claims data from the Centers for Medicare & Medicaid Services (CMS) with claims data from other payers to evaluate the performance of health care providers and suppliers. QEs must protect the privacy and security of the Medicare claims data and may use it only for purposes of the QE Program. While community-based groups across the United States have been working for two decades to better understand the quality and cost of health care within their communities, many of their efforts have focused on combining claims data from private payers within the community and sometimes from Medicaid programs. For the first time, organizations are able to analyze Medicare claims data alongside claims data from private payers and Medicaid. These new reports from QEs include care provided to the elderly and disabled population (a population with the greatest health care needs).

The first public report using Medicare data comes from the Oregon Health Care Quality Corporation (Q-Corp), an organization that produces data and analytics about the quality and utilization of health care in Oregon. Q-Corp was one of the first entities to be certified for Medicare data sharing. The addition of Medicare data has allowed Q-Corp to offer providers and consumers more complete information about the quality of care across the state of Oregon. The Medicare data has also allowed Q-Corp to publish quality measures for clinics that did not have a large enough patient population for reporting using only commercial and Medicaid data.

Today’s announcement is the latest of several efforts that demonstrate this Administration’s commitment to making health care performance and cost more transparent. As the single largest payer for health care in America, the CMS generates billions of data points each year. For decades, CMS has been an innovator in the use of this data.

Earlier this year, CMS released data on the services and procedures provided to Medicare beneficiaries by hospitals, physicians, and other health care professionals. These data, which do not include any personally identifiable information, summarize the utilization and payments for procedures and services provided to Medicare fee-for service beneficiaries by providers. With this information, consumers have unprecedented access to information about how care is delivered in the Medicare program. In addition, CMS continues to make data available to consumers through the Compare tools. These tools allow consumers to compare nursing homes, hospitals or physicians throughout the country based on the quality measures reported to CMS. People can use this information to inform their selection of a provider and to discuss outcomes and performance levels with their primary care physician before receiving a referral.

Q-Corp is one of 13 QEs currently certified by CMS. We are looking forward to additional public reports from other QEs to help drive health care data transparency, improve quality, and reduce costs in the coming year.

Accelerating states’ efforts on Medicaid delivery system reform

By Cindy Mann, Deputy Administrator and Director, Center for Medicaid & CHIP Services and Patrick Conway, M.D., Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer

As part of its commitment in working with states to improve care and improve health for Medicaid beneficiaries, and through these improvements, reduce costs, the Centers for Medicare & Medicaid Services (CMS) is launching a new collaborative initiative called the Medicaid Innovation Accelerator Program. Over $100 million will be invested over five years to help states accelerate the development and testing of new state-led payment and service delivery innovations to improve health, improve care and decrease costs for individuals enrolled in Medicaid.

Over the past few years, CMS has listened to and consulted with states and stakeholders on health care reform efforts. Based on these discussions and the recommendations from the National Governors Association’s (NGA) Health Care Sustainability Task Force, this initiative will focus on key targeted areas to support state leaders and jumpstart states’ efforts to undertake Medicaid delivery system and payment reform.

All states can be laboratories for health care reform. Fifteen states have initiated comprehensive health homes for people with multiple chronic conditions. Several states have developed shared savings payment models. Thirteen states are testing new delivery and payment models for people who are dually eligible for Medicaid and Medicare. And twenty-five states are currently participating in the CMS Innovation Center’s State Innovation Models initiative. While payment and service delivery innovation is well underway in states, there are gaps and challenges that can be addressed. The Medicaid Innovation Accelerator Program will help strengthen state Medicaid program capabilities in technical areas such as data analytics, service delivery and financial modeling, quality measurement and rapid cycle evaluation to move their Medicaid payment and service delivery models to the next level.  

We are excited to be able to offer this new set of technical assistance resources to state leaders to improve their health care systems and provide better health care for their residents with Medicaid, at lower cost.    

For more information on the Medicaid Innovation Accelerator Program, please visit:


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