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Review of Quality Measures Data Reported by Accountable Care Organizations in the Medicare Shared Savings Program

The Medicare Shared Savings Program (MSSP) was established by section 3022 of the Patient Protection and Affordable Care Act to facilitate coordination and cooperation among providers, improve quality of care for Medicare fee-for-service beneficiaries, and reduce unnecessary costs. Eligible providers and suppliers may voluntarily participate in the MSSP by creating or joining an Accountable Care Organization (ACO). ACOs that lower health care costs and meet quality performance standards for their beneficiary populations are eligible to share in any savings that the ACOs generate for the Medicare program (earned shared savings). To demonstrate that they are providing appropriate, high-quality care while reducing costs, ACOs are required to report complete and accurate data on quality measures and to satisfy minimum levels of certain quality measures as set by CMS. CMS assesses an ACO's overall quality performance by calculating a single quality performance score across all quality measures reported by the ACO. This score is used in part to calculate the ACO's earned shared savings. We will review MSSP ACOs that received earned shared savings payments to determine whether they reported quality measures data in accordance with Federal requirements. Our review is part of several OIG reviews that will examine various aspects of the ACOs under the MSSP.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Jun-17 Centers for Medicare & Medicaid Services Review of Quality Measures Data Reported by Accountable Care Organizations in the Medicare Shared Savings Program Office of Audit Services W-00-17-35798; A-09-17-03023 2018 2019