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Performance Year Financial and Quality Results PUF Data Dictionary
Term Name Variable Name Definition
ACO ID ACO_ID Unencrypted ACO Identifier. This identifier can be linked to the
encrypted ACO identifier used for prior performance years (PY) using
the ACO ID Crosswalk available at
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/sharedsavingsprogram/program-data.
ACO name ACO_Name ACO Doing Business As (DBA) or Legal Business Name (LBN). Listed
name is DBA unless DBA is not available, in which case LBN is used.
Agreement type Agree_Type Indicates whether an ACO is “Initial”, participating in an initial
agreement period; “Renewal”, in a second or subsequent agreement
period; or “Re-entering”, in an agreement period not defined as a
renewal. If a Re-entering ACO subsequently renews, the ACO is flagged
as a Renewal.
Agreement period
number
Agreement_Period_Num Numerical indicator of agreement period; =1 if ACO is in first
agreement period; =2 if ACO is in second agreement period; etc. For
Re-entering ACOs, agreement period number is determined at the
time of re-entry based on the number of agreement periods
completed by the by the same ACO prior to re-entry based on the
number of agreement periods completed by the prior ACO.
Current start date Current_Start_Date Agreement start date of current agreement period. This will be the
start date of the second or subsequent agreement period for ACOs
classified as a Renewal. This will be the start date of the current
agreement period for ACOs classified as Re-entering.
Track in current
performance year
Current_Track If ACO selected BASIC Level A (one-sided shared savings model) for
current performance year= A; BASIC Level B (one-sided shared savings
model) for current performance year= B; BASIC Level C (two-sided
shared savings / losses model) for current performance year= C;BASIC
Level D (two-sided shared savings / losses model) for current
performance year = D; BASIC Level E (two-sided shared savings / losses
model) for current performance year; ENHANCED (two-sided shared
savings / losses model) for current performance year= EN.
Risk Model Risk_Model Indicates whether an ACO is “One-Sided”, participating in a one-sided
shared savings model; or “Two-Sided”, participating in a two-sided
shared savings/losses model for the performance year.
Assignment
Methodology
Assign_Type Indicates whether an ACO is “Prospective”, under Prospective
Assignment; “Retrospective”, under Preliminary Prospective
Assignment with Retrospective Reconciliation.
Participate in Skilled
Nursing Facility (SNF)
3-Day Rule Waiver
SNF_Waiver 0/1 flag; =1 if ACO participates in SNF 3-day waiver; otherwise =0.
Total Assigned
Beneficiaries
N_AB Number of assigned beneficiaries, performance year.
Savings Rate Sav_rate Total Benchmark Expenditures Minus Assigned Beneficiary
Expenditures as a percent of Total Benchmark Expenditures.
Minimum Savings
Rate (%)
MinSavPerc If ACO is in a one-sided model, the Minimum Savings Rate is
determined on a sliding scale based on the number of assigned
beneficiaries. If ACO is in a two-sided model, the Minimum Savings
Rate (MSR) / Minimum Loss Rate (MLR) selected by the ACO at the
time of application to a two-sided model applies for the duration of
the ACO’s agreement period. For such ACOs, the MSR and MLR can be
set to: zero percent; symmetrical MSR/MLR in a 0.5 percent increment
between 0.5-2.0 percent; or symmetrical MSR/MLR determined on a
sliding scale based on the number of assigned beneficiaries.
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Term Name Variable Name Definition
Benchmark Minus
Expenditures
BnchmkMinExp Total Benchmark Expenditures Minus Assigned Beneficiary
Expenditures. If positive, represents total savings. If negative,
represents total losses.
Generated Total
Savings/Losses
GenSaveLoss Generated savings: Total savings (measured as Benchmark Minus
Expenditures, from first to last dollar) for ACOs whose savings rate
equaled or exceeded their MSR. This amount does not account for the
application of the ACO’s final sharing rate based on quality
performance, reduction due to sequestration, application of
performance payment limit, or repayment of advance payments.
Generated losses: Total losses (measured as Benchmark Minus
Assigned Expenditures, from first to last dollar) for ACOs in two-sided
models whose losses rate equaled or exceeded their MLR. This amount
does not account for the application of the ACO’s final sharing rate
based on quality performance or the loss sharing limit.
Extreme and
Uncontrollable
Circumstance
Adjustment - Financial
DisAdj If ACO is in one-sided model, blank (–). If ACO is in two-sided model
with losses outside their MLR, equal to shared losses after applying the
loss sharing limit, multiplied by percentage of beneficiaries in counties
affected by an extreme and uncontrollable circumstance (EUC) and
share of year affected by an EUC. For PY 2022 all counties in the United
States were affected by the public health emergency for COVID-19 for
the entirety of the year.
Impacted Mid-Year
Termination Flag
Impact_Mid_Year_Termination 0/1 flag; =1 if ACO is in a two-sided model and terminates its
participation agreement under §425.220 with an effective date of
termination after June 30th and prior to December 31st of the
performance year and is therefore responsible for a prorated share of
losses and is ineligible to receive shared savings; otherwise = 0.
Earned Shared Savings
Payments/Owed
Losses
EarnSaveLoss Total earned shared savings: The ACO’s share of savings for ACOs
whose savings rate equaled or exceeded their MSR, and who were
eligible for a performance payment because they met the program’s
quality performance standard. This amount accounts for the
application of the ACO’s final sharing rate based on quality
performance (based on ACO track), as well as the reduction in
performance payment due to sequestration and application of the
performance payment limit. This amount equals 0 if ACO is in a two-
sided model and terminates its participation agreement under
§425.220 with an effective date of termination after June 30th and
prior to December 31st of the performance year.
Total earned shared losses: The ACO’s share of losses for ACOs in two-
sided tracks whose losses rate equaled or exceeded their MLR, which is
the negative of the MSR chosen. This amount accounts for the
application of the ACO’s final loss sharing rate based on quality
performance (based on ACO track), the loss sharing limit, the EUC
adjustment, and any prorating of shared losses for an ACO in a two-
sided model that terminates its participation agreement under
§425.220 with an effective date of termination after June 30th and
prior to December 31st of the performance year.
Extreme and
Uncontrollable
Circumstance
Affected - Quality
DisAffQual 0/1 flag; = 1 if at least 20% of assigned beneficiaries (based on Q3
assignment for the performance year) reside in a county affected by an
EUC or ACO legal entity is located in such a county. Otherwise, equal to
0. For PY 2022 all ACOs receive value of 1 due to the public health
emergency for COVID-19.
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Term Name Variable Name Definition
Met the Quality
Performance Standard
Met_QPS 0/1 flag; =1 if ACO met the quality performance standard based on the
applicable methodology for a performance year; otherwise =0. For PY
2022, an ACO that reports quality data via the Alternative Payment
Model (APM) Performance Pathway (APP) can meet the quality
performance standard via one of three pathways: (1) achieving a
quality performance score that is equivalent to or higher than the 30th
percentile across all MIPS Quality performance category (QPC) scores,
excluding entities/providers eligible for facility-based scoring; (2)
meeting the criteria for the electronic clinical quality measure
(eCQM)/Merit-based Incentive Payment System clinical quality
measure (MIPS CQM) reporting incentive; or (3) meeting the quality
reporting criteria as a 1st year ACO. An ACO must meet the quality
performance standard to be eligible to share in savings at the
maximum sharing rate and avoid maximum shared losses under
certain payment tracks.
Met or exceeded 30th
percentile MIPS QPC
score
Met_30pctl 0/1/ flag; =1 if ACO achieved a quality performance score that is
equivalent to or higher than the 30th percentile across all MIPS QPC
scores, excluding entities/providers eligible for facility-based scoring;
otherwise =0. For PY 2022, all Shared Savings Program ACOs were
determined to have been affected by an EUC and were eligible to have
the Shared Savings Program Quality EUC policy applied. Under the
Savings Program Quality EUC policy, if the ACO was able to report
quality data via the APP and met the MIPS data completeness and case
minimum requirements, the ACO’s quality performance score was set
to the higher of the ACO’s quality performance score or the equivalent
of the 30th percentile MIPS QPC score across all MIPS QPC scores,
excluding entities/providers eligible for facility-based scoring. If the
ACO was unable to report quality data and meet the MIPS data
completeness and case minimum requirements, the ACO’s quality
performance score was set equal to the 30th percentile MIPS QPC
score across all MIPS QPC scores, excluding entities/providers eligible
for facility-based scoring.
Met the eCQM/CQM
Reporting Incentive
Met_Incentive 0/1 flag; =1 if ACO met the eCQM/MIPS CQM reporting incentive;
otherwise =0. In PY 2022, an ACO meets the eCQM/MIPS CQM
reporting incentive by reporting the three eCQMs/MIPS CQMs,
meeting the MIPS data completeness and case minimum requirements
for all three measures and by achieving a quality performance score
equivalent to or higher than the 10th percentile of the performance
benchmark on at least one of the four outcome measures in the APP
measure set and a quality performance score equivalent to or higher
than the 30th percentile of the performance benchmark on at least
one of the five remaining measures in the APP measure set.
ACO is 1st Year ACO
that met reporting
criteria
Met_FirstYear 0/1 flag; =1 if for the first performance year of an ACO's first
agreement period under the Shared Savings Program, the ACO
reported the ten CMS Web Interface measures or the three
eCQMs/MIPS CQMs and administered a Consumer Assessment of
Healthcare Providers and Systems (CAHPS) for MIPS Survey under the
APP and met MIPS data completeness and case minimum
requirements for all of the measures; otherwise =0.
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Term Name Variable Name Definition
Reported CMS Web
Interface Measure Set
Report_WI 0/1 flag; 1 = if the ACO reported quality by the CMS Web Interface
reporting option; otherwise = 0.
In PY 2022, ACOs were required to report the 10 measures under the
CMS Web Interface or the 3 eCQM/MIPS CQMs. ACOs were also
required to administer the CAHPS for MIPS survey. CMS calculated the
Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate
for MIPS Eligible Clinician Groups and Clinician and Clinician Group
Risk-standardized Hospital Admission Rates for Patients with Multiple
Chronic Conditions (MCC) measures using administrative claims data.
Based on the ACO’s chosen reporting option, either 6 or 10 measures
were included in calculating the ACO’s MIPS QPC score. ACOs that
chose to report both the CMS Web Interface measures and
eCQM/MIPS CQMs received a MIPS QPC score based on whichever
measure set resulted in a higher score.
Note: The ACO quality performance score and performance rates
populated in the PUF for an ACO are from the highest scoring reporting
option, which was used for financial reconciliation.
Reported eCQMs or
MIPS CQMs
Report_eCQM_CQM 0/1 flag; 1 = if the ACO reported quality by eCQMs, MIPS CQMs, or
both eCQMs/MIPS CQMs; otherwise = 0.
In PY 2022, ACOs were required to report the 10 measures under the
CMS Web Interface or the 3 eCQMs/MIPS CQMs. ACOs were also
required to administer the CAHPS for MIPS survey. CMS calculated the
HWR and MCC measures using administrative claims data. Based on
the ACO’s chosen reporting option, either 6 or 10 measures were
included in calculating the MIPS QPC score. ACOs that chose to report
both the CMS Web Interface measures and eCQMs/MIPS CQMs
received a MIPS QPC score based on whichever measure set resulted
in a higher quality score.
Note: The ACO quality performance score and performance rates
populated in the PUF for an ACO are from the highest scoring reporting
option, which was used for financial reconciliation.
Incomplete Reporting Report_Inc 0/1 flag; 1 = if the ACO did not report any of the 10 CMS Web Interface
measures or any of the 3 eCQMs/MIPS CQMs under the APP;
otherwise = 0.
In PY 2022, ACOs were required to report the 10 measures under the
CMS Web Interface or the 3 eCQMs/MIPS CQMs. ACOs were also
required to administer the CAHPS for MIPS survey. CMS calculated the
HWR and MCC measures using administrative claims data. Based on
the ACO’s chosen reporting option, either 6 or 10 measures were
included in calculating the MIPS QPC score.
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Term Name Variable Name Definition
Quality Performance
Score
QualScore Quality performance score: ACO’s quality performance score based on
applicable methodology for a performance year. In PY 2022, an ACO’s
quality performance score was calculated using the ACO’s performance
on the quality measures reported under APP and any applicable quality
improvement points. For PY 2022, all Shared Savings Program ACOs
were eligible to have the Shared Savings Program Quality EUC policy
applied. Under the Savings Program Quality EUC policy, if the ACO was
able to report quality data via the APP and met the MIPS data
completeness and case minimum requirements, the ACO’s quality
performance score was set to the higher of the ACO’s quality
performance score or the equivalent of the 30th percentile MIPS QPC
score across all MIPS QPC scores, excluding entities/providers eligible
for facility-based scoring. If the ACO was unable to report quality data
and meet the MIPS data completeness and case minimum
requirements, the ACO’s quality performance score was set equal to
the 30th percentile MIPS QPC score across all MIPS QPC scores,
excluding entities/providers eligible for facility-based scoring.
Extreme and
Uncontrollable
Circumstance- 30th
Percentile
Adjustment-Quality
Recvd30p 0/1 flag; =1 if ACO had its quality performance score set equal to the
30th percentile MIPS QPC score across all MIPS QPC scores, excluding
entities/providers eligible for facility-based scoring, under the Shared
Savings Program Quality EUC policy. =0 if ACO received its own MIPS
QPC score as its quality performance score rather than the 30th
percentile MIPS QPC score.
Positive Regional
Adjustment
PosRegAdj Value of the aggregate regional adjustment applied to the historical
benchmark. The regional adjustment is computed separately by
enrollment type and is determined by the difference in the ACO’s
spending relative to its regional service area. This value represents the
weighted average of these enrollment type specific adjustments. A
positive value indicates the ACO had lower spending than its regional
service area while a negative value indicates the ACO had higher
spending than its regional service area.
Updated benchmark
expenditures
UpdatedBnchmk Updated benchmark is compared to ACO performance year
expenditures and is used to determine ACO savings/losses in the
performance year. As part of updating benchmark, benchmark
expenditures are risk-adjusted in the historical benchmark period and
performance period to account for changes in the ACO's assigned
populations over time. Updated benchmark also includes the blended
national-regional update factor (for all ACOs that entered an
agreement period beginning on or after July 1, 2019).
Historical benchmark HistBnchmk Single per capita historical benchmark value reflecting ACO’s applicable
benchmarking methodology. For ACOs that entered an agreement
period on or after July 2019, the benchmark is calculated using a blend
of national and regional assignable FFS expenditure trend factors and
incorporates a regional adjustment subject to a cap.
Total benchmark
expenditures
ABtotBnchmk Per capita benchmark (UpdatedBnchmk) multiplied by total person
years (N_AB_Year).
Total expenditures ABtotExp Per capita performance year expenditures (Per_Capita_Exp_TOTAL)
multiplied by total person years (N_AB_Year).
Final sharing rate FinalShareRate Equal to maximum sharing rate, which is the maximum percentage of
savings an ACO can share based on the ACO’s track, before accounting
for quality performance. Set to 40% for BASIC Track Levels A and B,
50% for BASIC Track Levels C, D, and E, and 75% for ENHANCED Track.
The percentage of savings an ACO shares if the ACO is eligible for
shared savings. Will equal zero if ACO failed to meet quality
performance standard.
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Term Name Variable Name Definition
Indicates whether a
high or low revenue
ACO
Rev_Exp_Cat If ACO participant total Medicare Parts A and B FFS revenue for the
performance year is less than 35% of the total Medicare Parts A and B
FFS expenditures for the ACO’s assigned beneficiaries for the
performance year, “Low Revenue”. If ACO participant total Medicare
Parts A and B FFS revenue for the performance year is 35% or more of
the total Medicare Parts A and B FFS expenditures for the ACO’s
assigned beneficiaries for the performance year, “High Revenue”.
Per capita ESRD
expenditures in
benchmark year 1
Per_Capita_Exp_ALL_ESRD_BY1 Annualized, truncated, weighted mean total expenditures per ESRD
assigned beneficiary person years in benchmark year 1.
Per capita DISABLED
expenditures in
benchmark year 1
Per_Capita_Exp_ALL_DIS_BY1 Annualized, truncated, weighted mean total expenditures per
DISABLED assigned beneficiary person years in benchmark year 1.
Per capita
AGED/DUAL
expenditures in
benchmark year 1
Per_Capita_Exp_ALL_AGDU_BY1 Annualized, truncated, weighted mean total expenditures per
AGED/DUAL assigned beneficiary person years in benchmark year 1.
Per capita
AGED/NON-DUAL
expenditures in
benchmark year 1
Per_Capita_Exp_ALL_AGND_BY1 Annualized, truncated, weighted mean total expenditures per
AGED/NON-DUAL assigned beneficiary person years in benchmark year
1.
Per capita ESRD
expenditures in
benchmark year 2
Per_Capita_Exp_ALL_ESRD_BY2 Annualized, truncated, weighted mean total expenditures per ESRD
assigned beneficiary person years in benchmark year 2.
Per capita DISABLED
expenditures in
benchmark year 2
Per_Capita_Exp_ALL_DIS_BY2 Annualized, truncated, weighted mean total expenditures per
DISABLED assigned beneficiary person years in benchmark year 2.
Per capita
AGED/DUAL
expenditures in
benchmark year 2
Per_Capita_Exp_ALL_AGDU_BY2 Annualized, truncated, weighted mean total expenditures per
AGED/DUAL assigned beneficiary person years in benchmark year 2.
Per capita
AGED/NON-DUAL
expenditures in
benchmark year 2
Per_Capita_Exp_ALL_AGND_BY2 Annualized, truncated, weighted mean total expenditures per
AGED/NON-DUAL assigned beneficiary person years in benchmark year
2.
Per capita ESRD
expenditures in
benchmark year 3
Per_Capita_Exp_ALL_ESRD_BY3 Annualized, truncated, weighted mean total expenditures per ESRD
assigned beneficiary person years in benchmark year 3.
Per capita DISABLED
expenditures in
benchmark year 3
Per_Capita_Exp_ALL_DIS_BY3 Annualized, truncated, weighted mean total expenditures per
DISABLED assigned beneficiary person years in benchmark year 3.
Per capita
AGED/DUAL
expenditures in
benchmark year 3
Per_Capita_Exp_ALL_AGDU_BY3 Annualized, truncated, weighted mean total expenditures per
AGED/DUAL assigned beneficiary person years in benchmark year 3.
Per capita
AGED/NON-DUAL
expenditures in
benchmark year 3
Per_Capita_Exp_ALL_AGND_BY3 Annualized, truncated, weighted mean total expenditures per
AGED/NON-DUAL assigned beneficiary person years in benchmark year
3.
Per capita ESRD
expenditures in
performance year
Per_Capita_Exp_ALL_ESRD_PY Annualized, truncated, weighted mean total expenditures per ESRD
assigned beneficiary person years in the performance year.
Per capita DISABLED
expenditures in
performance year
Per_Capita_Exp_ALL_DIS_PY Annualized, truncated, weighted mean total expenditures per
DISABLED assigned beneficiary person years in the performance year.
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Term Name Variable Name Definition
Per capita
AGED/DUAL
expenditures in
performance year
Per_Capita_Exp_ALL_AGDU_PY Annualized, truncated, weighted mean total expenditures per
AGED/DUAL assigned beneficiary person years in the performance
year.
Per capita
AGED/NON-DUAL
expenditures in
performance year
Per_Capita_Exp_ALL_AGND_PY Annualized, truncated, weighted mean total expenditures per
AGED/NON-DUAL assigned beneficiary person years in the
performance year.
Per capita ALL
expenditures in
performance year
Per_Capita_Exp_TOTAL_PY Annualized, truncated, weighted mean total expenditures per assigned
beneficiary person years in the performance year.
Average ESRD HCC
risk score in
benchmark year 1
CMS_HCC_RiskScore_ESRD_BY1 Final, mean prospective CMS-HCC risk score for ESRD enrollment type
in benchmark year 1.
Average DISABLED
HCC risk score in
benchmark year 1
CMS_HCC_RiskScore_DIS_BY1 Final, mean prospective CMS-HCC risk score for DISABLED enrollment
type in benchmark year 1.
Average AGED/DUAL
HCC risk score in
benchmark year 1
CMS_HCC_RiskScore_AGDU_BY1 Final, mean prospective CMS-HCC risk score for AGED/DUAL
enrollment type in benchmark year 1.
Average AGED/NON-
DUAL HCC risk score
in benchmark year 1
CMS_HCC_RiskScore_AGND_BY1 Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL
enrollment type in benchmark year 1.
Average ESRD HCC
risk score in
benchmark year 2
CMS_HCC_RiskScore_ESRD_BY2 Final, mean prospective CMS-HCC risk score for ESRD enrollment type
in benchmark year 2.
Average DISABLED
HCC risk score in
benchmark year 2
CMS_HCC_RiskScore_DIS_BY2 Final, mean prospective CMS-HCC risk score for DISABLED enrollment
type in benchmark year 2.
Average AGED/DUAL
HCC risk score in
benchmark year 2
CMS_HCC_RiskScore_AGDU_BY2 Final, mean prospective CMS-HCC risk score for AGED/DUAL
enrollment type in benchmark year 2.
Average AGED/NON-
DUAL HCC risk score
in benchmark year 2
CMS_HCC_RiskScore_AGND_BY2 Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL
enrollment type in benchmark year 2.
Average ESRD HCC
risk score in
benchmark year 3
CMS_HCC_RiskScore_ESRD_BY3 Final, mean prospective CMS-HCC risk score for ESRD enrollment type
in benchmark year 3.
Average DISABLED
HCC risk score in
benchmark year 3
CMS_HCC_RiskScore_DIS_BY3 Final, mean prospective CMS-HCC risk score for DISABLED enrollment
type in benchmark year 3.
Average AGED/DUAL
HCC risk score in
benchmark year 3
CMS_HCC_RiskScore_AGDU_BY3 Final, mean prospective CMS-HCC risk score for AGED/DUAL
enrollment type in benchmark year 3.
Average AGED/NON-
DUAL HCC risk score
in benchmark year 3
CMS_HCC_RiskScore_AGND_BY3 Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL
enrollment type in benchmark year 3.
Average ESRD HCC
risk score in
performance year
CMS_HCC_RiskScore_ESRD_PY Final, mean prospective CMS-HCC risk score for ESRD enrollment type
in the performance year.
Average DISABLED
HCC risk score in
performance year
CMS_HCC_RiskScore_DIS_PY Final, mean prospective CMS-HCC risk score for DISABLED enrollment
type in the performance year.
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Term Name Variable Name Definition
Average AGED/DUAL
HCC risk score in
performance year
CMS_HCC_RiskScore_AGDU_PY Final, mean prospective CMS-HCC risk score for AGED/DUAL
enrollment type in the performance year.
Average AGED/NON-
DUAL HCC risk score
in performance year
CMS_HCC_RiskScore_AGND_PY Final, mean prospective CMS-HCC risk score for AGED/NON-DUAL
enrollment type in the performance year.
ESRD person years in
benchmark year 3
N_AB_Year_ESRD_BY3 Number of assigned beneficiaries with ESRD enrollment type in
benchmark year 3 adjusted for the total number of months that each
beneficiary was classified as ESRD; Number of ESRD person-months
divided by 12.
DISABLED person
years in benchmark
year 3
N_AB_Year_DIS_BY3 Number of assigned beneficiaries with DISABLED enrollment type in
benchmark year 3 adjusted for the total number of months that each
beneficiary was classified as DISABLED; Number of DISABLED person-
months divided by 12.
AGED/DUAL person
years in benchmark
year 3
N_AB_Year_AGED_Dual_BY3 Number of assigned beneficiaries with AGED/DUAL enrollment type in
benchmark year 3 adjusted for the total number of months that each
beneficiary was classified as AGED/DUAL; Number of AGED/DUAL
person-months divided by 12.
AGED/NON-DUAL
person years in
benchmark year 3
N_AB_Year_AGED_NonDual_BY3 Number of assigned beneficiaries with AGED/NON-DUAL enrollment
type in benchmark year 3 adjusted for the total number of months that
each beneficiary was classified as AGED/NON-DUAL; Number of
AGED/NON-DUAL person-months divided by 12.
Total person years in
performance year
N_AB_Year_PY Number of assigned beneficiaries in the performance year adjusted
downwards for beneficiaries with less than a full 12 months of
eligibility; Number of person-months divided by 12.
ESRD person years in
performance year
N_AB_Year_ESRD_PY Number of assigned beneficiaries with ESRD enrollment type in the
performance year adjusted for the total number of months that each
beneficiary was classified as ESRD; Number of ESRD person-months
divided by 12.
DISABLED person
years in performance
year
N_AB_Year_DIS_PY Number of assigned beneficiaries with DISABLED enrollment type in
the performance year adjusted for the total number of months that
each beneficiary was classified as DISABLED; Number of DISABLED
person-months divided by 12.
AGED/DUAL person--
years in performance
year
N_AB_Year_AGED_Dual_PY Number of assigned beneficiaries with AGED/DUAL enrollment type in
the performance year adjusted for the total number of months that
each beneficiary was classified as AGED/DUAL; Number of AGED/DUAL
person-months divided by 12.
AGED/NON-DUAL
person years in
performance year
N_AB_Year_AGED_NonDual_PY Number of assigned beneficiaries with AGED/NON-DUAL enrollment
type in the performance year adjusted for the total number of months
that each beneficiary was classified as AGED/NON-DUAL; Number of
AGED/NON-DUAL person-months divided by 12.
Beneficiaries assigned
through voluntary
alignment only
N_Ben_VA_Only Number of assigned beneficiaries assigned through voluntary
alignment only.
Beneficiaries assigned
through claims-based
assignment only
N_Ben_CBA_Only Number of assigned beneficiaries assigned through claims-based
assignment only.
Beneficiaries assigned
through claims-based
assignment and
voluntary alignment
N_Ben_CBA_and_VA Number of assigned beneficiaries assigned through claims-based
assignment and voluntary alignment.
Total assigned
beneficiaries, age 0-64
N_Ben_Age_0_64 Total number of assigned beneficiaries, age 0-64 in the calendar year;
age calculated as of February 1 of the calendar year. Based on most
current date of birth in Medicare records.
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Term Name Variable Name Definition
Total assigned
beneficiaries, age 65-
74
N_Ben_Age_65_74 Total number of assigned beneficiaries, age 65-74 in the calendar year;
age calculated as of February 1 of the calendar year. Based on most
current date of birth in Medicare records.
Total assigned
beneficiaries, age 75-
84
N_Ben_Age_75_84 Total number of assigned beneficiaries, age 75-84 in the calendar year;
age calculated as of February 1 of the calendar year. Based on most
current date of birth in Medicare records.
Total assigned
beneficiaries, age 85+
N_Ben_Age_85plus Total number of assigned beneficiaries, age 85+ in the calendar year
age calculated as of February 1 of the calendar year. Based on most
current date of birth in Medicare records.
Total assigned
beneficiaries, female
N_Ben_Female Total number of assigned beneficiaries, female (Gender=2) in the
calendar year. Based on most current gender in Medicare records.
Total assigned
beneficiaries, male
N_Ben_Male Total number of assigned beneficiaries, male (Gender=1) in the
calendar year. Based on most current gender in Medicare records.
Total assigned
beneficiaries, Non-
Hispanic White
N_Ben_Race_White Total number of assigned beneficiaries, Non-Hispanic White (Race=1)
in the calendar year. Based on most current race in Medicare records.
Total assigned
beneficiaries, Black
N_Ben_Race_Black Total number of assigned beneficiaries, Black (Race=2) in the calendar
year. Based on most current race in Medicare records.
Total assigned
beneficiaries, Asian
N_Ben_Race_Asian Total number of assigned beneficiaries, Asian (Race=4) in the calendar
year. Based on most current race in Medicare records.
Total assigned
beneficiaries, Hispanic
N_Ben_Race_Hisp Total number of assigned beneficiaries, Hispanic (Race=5) in the
calendar year. Based on most current race in Medicare records.
Total assigned
beneficiaries, North
American Native
N_Ben_Race_Native Total number of assigned beneficiaries, North American Native
(Race=6) in the calendar year. Based on most current race in Medicare
records.
Total assigned
beneficiaries, Other
N_Ben_Race_Other Total number of assigned beneficiaries, Other (Race= 3) in the calendar
year. Based on most current race in Medicare records.
Total assigned
beneficiaries,
Unknown
N_Ben_Race_Unknown Total number of assigned beneficiaries, Unknown (Race=0) and Missing
(Race=~) in the calendar year. Based on most current race in Medicare
records.
Total Inpatient
expenditures
CapAnn_INP_All Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for inpatient services for assigned
beneficiaries in the performance year. Includes all hospital provider
types including but not limited to short term acute care hospital, long
term care hospital, rehabilitation hospital or unit, and psychiatric
hospital or unit. Because total hospital inpatient facility expenditures
and expenditures by hospital provider type are each truncated at the
same level as total expenditures, expenditures by hospital provider
type may not sum to total hospital inpatient facility expenditures.
Inpatient claims are identified by claim type code 60.
Short term acute care
hospital (IPPS/CAH)
expenditures
CapAnn_INP_S_trm Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for acute care inpatient services in a short
term acute care (Inpatient Prospective Payment System (IPPS) or
Critical Access Hospital (CAH) setting for assigned beneficiaries in the
performance year. Inpatient claims are identified by claim type code
60. Short term acute care hospitals are identified by CMS Certification
Number (CCN) where the 3rd through 6th digits are between 0001 -
0879. CAHs are identified by CCNS where the 3rd through 6th digits are
between 1300 - 1399.
Long term care
hospital expenditures
CapAnn_INP_L_trm Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for inpatient services in a long term care
setting for assigned beneficiaries in the performance year. Inpatient
claims are identified by claim type code 60. Long term care hospitals
are identified by CCNs where the 3rd through 6th digits are between
2000 - 2299.
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Term Name Variable Name Definition
Inpatient
rehabilitation facility
(IRF) expenditures
CapAnn_INP_Rehab Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for inpatient services in a rehabilitation
facility or unit for assigned beneficiaries in the performance year.
Inpatient claims are identified by claim type code 60. Inpatient
rehabilitation facilities are identified by CCNs where the 3rd through
6th digits are between 3025 - 3099 or where the 3rd byte is equal to R
or T.
Inpatient psychiatric
hospital expenditures
CapAnn_INP_Psych Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for inpatient services in a psychiatric hospital
facility or unit for assigned beneficiaries in the performance year.
Inpatient claims are identified by claim type code 60. Psychiatric
hospitals are identified by CCNs where the 3rd through 6th digits are
between 4000 - 4499 or where the 3rd byte is equal to M or S.
Hospice expenditures CapAnn_HSP Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for hospice services for assigned beneficiaries
in the performance year. Hospice claims are identified by claim type
code 50.
Skilled nursing facility
or unit expenditures
CapAnn_SNF Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for services in a SNF setting for assigned
beneficiaries in the performance year. SNF claims are identified by
claim type codes 20 and 30).
Outpatient
expenditures
CapAnn_OPD Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for outpatient services for assigned
beneficiaries in the performance year. Includes all outpatient facility
types including, but not limited to, hospital outpatient departments,
outpatient dialysis facilities, Federally Qualified Health Center (FQHC),
Rural Health Clinic (RHC), outpatient rehabilitation facilities, and
community mental health centers. Outpatient claims are identified by
claim type code 40.
Physician/supplier
expenditures
CapAnn_PB Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for Part B physician/supplier (Carrier) services
for assigned beneficiaries in the performance year. Includes all Part B
physician/supplier services including, but not limited to, evaluation and
management, procedures, imaging, laboratory and other test, Part B
drugs, and ambulance services. In addition to physician and other
practitioner services, includes free-standing ambulatory surgery
centers, independent clinical laboratories, and other suppliers.
Includes physician/practitioner services provided in either an inpatient
or outpatient setting. Physician/supplier claims are identified by claim
type codes 71 and 72.
Ambulance
expenditures
CapAnn_AmbPay Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for ambulance services for assigned
beneficiaries in the performance year. Ambulance services are
identified in the Part B physician/supplier (Carrier) claims (claim type
codes 71 and 72) by Restructured BETOS Code System (RBCS) codes
OA004N, OA002N, OA001N, or OA003N..[PA1]
Home health
expenditures
CapAnn_HHA Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for home health agency services for assigned
beneficiaries in the performance year. Home health claims are
identified by claim type code 10.
Durable medical
equipment
expenditures
CapAnn_DME Annualized, truncated, weighted mean expenditures per assigned
beneficiary person years for durable medical equipment (DME) for
assigned beneficiaries in the performance year. DME claims are
identified by claim type codes 81 and 82.
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Term Name Variable Name Definition
Inpatient hospital
discharges
ADM Total number of inpatient hospital discharges per 1,000 person years in
the performance year. A beneficiary is flagged for having a
hospitalization if the beneficiary had at least one inpatient claim during
the performance year. Each hospitalization is defined as a set of claims
with the same Medicare Beneficiary Identifier (MBI), same admission
date, and same provider number. Adjusted for short-term acute-care
transfers by combining two admissions into one when the second
admission was within one day of the discharge date of the first
admission. Inpatient claims are identified by claim type code 60.
Hospitals are identified on inpatient claims through the last four
characters of the CMS Certification Number (CCN). The relevant ranges
for the last four characters of the CCN on the claims are: 0001-0899;
9800-9899; 1225-1299; 1300-1399; 2000-2299; 3025-3099; T001-T899;
R225-R399; 4000-4499; S001-S899; M225-M399; 1990-1999; 3300-
3399.
Short term hospital
discharges
ADM_S_Trm Total number of short term hospital discharges per 1,000 person years
in the performance year. A beneficiary is flagged for having a
hospitalization if the beneficiary had at least one inpatient claim during
the performance year. Each hospitalization is defined as a set of claims
with the same MBI, same admission date, and same provider number.
Short term acute care hospitals are identified by CCNs where the 3rd
through 6th digits are between 0001 - 0879. CAHs are identified by
CCNs where the 3rd through 6th digits are between 1300 - 1399.
Inpatient claims are identified by claim type code 60
Long-term hospital
discharges
ADM_L_Trm Total number of long-term care hospital (LTCH) discharges per 1,000
person years in the performance year. A beneficiary is flagged for
having a hospitalization in a long-term hospital if the beneficiary had at
least one inpatient claim during the performance year. Each
hospitalization is defined as a set of claims with the same MBI, same
admission date, and same provider number[PA2] . CMS adjusts for
transfers by combining two admissions into one when the second
admission was within one day of the discharge date of the first
admission. Inpatient claims are identified by claim type code 60. Long
term care hospitals are identified by CCNs where the 3rd through 6th
digits are between 2000 - 2299.
Rehabilitation hospital
or unit discharges
ADM_Rehab Total number of inpatient rehabilitation facility (IRF) discharges per
1,000 person years in the performance year. A beneficiary is flagged
for having a hospitalization in a rehabilitation hospital or unit if the
beneficiary had at least one inpatient claim during the performance
year. Each hospitalization is defined as a set of claims with the same
MBI, same admission date, and same provider number. Inpatient
claims are identified by claim type code 60. Inpatient rehabilitation
facilities are identified by CCNs where the 3rd through 6th digits are
between 3025 - 3099 or where the 3rd byte is equal to R or T.
Psychiatric hospital or
unit discharges
ADM_Psych Total number of inpatient psychiatric facility (IPF) discharges per 1,000
person years in the performance year. A beneficiary is flagged for
having a hospitalization in a psychiatric hospital or unit if the
beneficiary had at least one inpatient claim during the performance
year. Each hospitalization is defined as a set of claims with the same
MBI, same admission date, and same provider number. Inpatient
claims are identified by claim type code 60. Psychiatric hospitals are
identified by CCNs where the 3rd through 6th digits are between 4000
- 4499 or where the 3rd byte is equal to M or S.
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Term Name Variable Name Definition
Outpatient ED visits P_EDV_Vis Total number of visits to an outpatient emergency department (ED)
per 1,000 person years in the performance year. An Emergency
Department Visit (EDV) is defined using both Inpatient & Outpatient
claims and using the Revenue Center Code field on the claims: EDVs in
the hospital inpatient and hospital outpatient claims with revenue
center code values 0450-0459 and 0981. The restriction is imposed
that a beneficiary could have a maximum of one EDV on a specific
date.
Emergency
Department Visits
that lead to a
Hospitalization
P_EDV_Vis_HOSP Total number of visits to an ED that result in an inpatient stay per
1,000 person years in the performance year. EDVs that Lead to
Hospitalizations is identified in the hospital inpatient claims with
revenue center code values 0450-0459 and 0981[PA3] . Multiple
emergency department claims on the same date are counted as a
single EDV.
CT events P_CT_VIS Total number of computed tomography (CT) events per 1,000 person
years in the performance year. CT imaging events are defined based on
claim type codes 71 or 72 and RBCS codes IC000N, IC003N, IC006N,
IC007N, and IC021N.
MRI events P_MRI_VIS Total number of magnetic resonance imaging (MRI) events per 1,000
person years in the performance year. MRI imaging events are defined
based on claim type codes 71 or 72 and RBCS codes IM009N, IM010N,
IM020N, IM022N, and IM023N.
Primary care services P_EM_Total Total number of primary care services per 1,000 person years in the
performance year. Primary care services are counted regardless of
physician specialty.
Primary care services
with a primary care
physician (PCP)
P_EM_PCP_Vis Total number of primary care services provided by a PCP per 1,000
person years in the performance year. Defined as a qualifying visit with
a primary care physician with a CMS specialty code of 1 (general
practice), 8 (family practice), 11 (internal medicine), 37 (pediatric
medicine), or [PA4] 38 (geriatric medicine). This includes primary care
services provided at Method II CAHs.
Primary care services
with a specialist
P_EM_SP_Vis Total number of primary care services provided by a specialist per
1,000 person years in the performance year.
Primary care services
with a NP/PA/CNS
P_Nurse_Vis Total number of primary care services provided by a nurse practitioner
(NP), physician's assistant (PA), or clinical nurse specialist (CNS) per
1,000 person years in the performance year. Defined as a qualifying
visit with practitioner with a CMS specialty code of 50 (NP), 89 (CNS),
and 97 (PA).
Primary care services
with a FQHC/RHC
P_FQHC_RHC_Vis Total number of primary care services provided at a FQHC or RHC per
1,000 person years in the performance year[PA5] [WK6] . Bill types are
used to identify classes of claims from these providers: RHC claims are
71x bill types. FQHC claims are 73x (for dates of service before April 1,
2010) and 77x (for dates of service on or after April 1, 2010).
Skilled nursing facility
discharges
P_SNF_ADM Total number of discharges from a skilled nursing facility per 1,000
person years in the performance year. Each SNF stay is defined as a set
of claims with the same MBI, same admission date, and same provider
number. We adjust for transfers by combining two stays into one when
the second admission was within one day of the discharge date of the
first admission, or when the second admission was at the same SNF
and was within three days of the discharge date of the first admission.
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Term Name Variable Name Definition
Skilled nursing facility
length of stay
SNF_LOS Average number of Medicare covered utilization days for entire SNF
stay for stays with a discharge date in the performance year. Each SNF
stay is defined as a set of claims with the same MBI, same admission
date, and same provider number. We adjust for transfers by combining
two stays into one when the second admission was within one day of
the discharge date of the first admission, or when the second
admission was at the same SNF and was within three days of the
discharge date of the first admission.
Skilled nursing facility
payment per stay
SNF_PayperStay Average Medicare expenditure per SNF stay. Includes entire facility
payment for stays with discharge date in the performance year. Each
SNF stay is defined as a set of claims with the same MBI, same
admission date, and same provider number. We adjust for transfers by
combining two stays into one when the second admission was within
one day of the discharge date of the first admission, or when the
second admission was at the same SNF and was within three days of
the discharge date of the first admission.
Number of CAHs N_CAH Total number of Critical Access Hospitals (CAHs) participating in the
ACO in the performance year. Based on the ACO's certified participant
list used in financial reconciliation and information in the Medicare
Provider Enrollment, Chain, and Ownership System (PECOS).
Number of FQHCs N_FQHC Total number of FQHCs participating in the ACO in the performance
year. Based on the ACO's certified participant list used in financial
reconciliation and information in PECOS.
Number of RHCs N_RHC Total number of RHCs participating in the ACO in the performance
year. Based on the ACO's certified participant list used in financial
reconciliation and information in PECOS.
Number of Elected
Teaching Amendment
(ETA) hospitals
N_ETA Total number of ETA hospitals participating in the ACO in the
performance year. Based on the ACO's certified participant list used in
financial reconciliation and information in PECOS.
Number of short-term
acute care hospitals
N_Hosp Total number of short-term acute care hospitals (excluding CAHs and
ETA hospitals) participating in the ACO in the performance year. Based
on the ACO’s certified participant list used in financial reconciliation
and information in PECOS.
Number of other
facility types
N_Fac_Other Total number of other facilities participating in the ACO in the
performance year. Based on the ACO's certified participant list used in
financial reconciliation and information in PECOS.
Number of
participating PCPs
N_PCP Total number of primary care physicians (PCPs) that reassigned billing
rights to an ACO participant in the performance year. Based on the
ACO's certified participant list used in financial reconciliation and
information in PECOS. PCPs include the following specialties: General
Practice,
Family Practice, Internal Medicine, Pediatric Medicine and Geriatric
Medicine.
Number of
participating
specialists
N_Spec Total number of physician specialists that reassigned billing rights to an
ACO participant in the performance year. Based on the ACO's certified
participant list used in financial reconciliation and information in
PECOS and claims submitted through ACO participant TINs.
Number of
participating nurse
practitioners
N_NP Total number of nurse practitioners that reassigned billing rights to an
ACO participant in the performance year. Based on the ACO's certified
participant list used in financial reconciliation and information in
PECOS and claims submitted through ACO participant TINs.
Number of
participating physician
assistants
N_PA Total number of physician assistants that reassigned billing rights to an
ACO participant in the performance year. Based on the ACO's certified
participant list used in financial reconciliation and information in
PECOS and claims submitted through ACO participant TINs.
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Term Name Variable Name Definition
Number of
participating clinical
nurse specialists
N_CNS Total number of clinical nurse specialists that reassigned billing rights
to an ACO participant in the performance year. Based on the ACO's
certified participant list used in financial reconciliation and information
in PECOS and claims submitted through ACO participant TINs.
Proportion of Dual
Beneficiaries
Perc_Dual The percentage of an ACO’s assigned beneficiaries that have dual
eligibility status (e.g. were simultaneously enrolled in both Medicare
and Medicaid for at least one month during the performance year)
Share of Beneficiaries
with COVID-19
Diagnosis
Perc_CovDiag The percentage of an ACO’s assigned beneficiaries that had a COVID-19
diagnosis during the performance year.
Share of Beneficiaries
with COVID-19
Episode
Perc_CovEpisode The percentage of an ACO’s assigned beneficiaries that had a COVID-19
episode during the performance year.
Share of Long-Term
Institutionalized
Beneficiaries
Perc_LTI The percentage of an ACO’s assigned beneficiaries that are a long-term
resident of an institution.
CAHPS: Getting Timely
Care, Appointments,
and Information
CAHPS_1 CAHPS: Getting Timely Care, Appointments, and Information
CAHPS: How Well
Your Providers
Communicate
CAHPS_2 CAHPS: How Well Your Providers Communicate
CAHPS: Patients’
Rating of Provider
CAHPS_3 CAHPS: Patients’ Rating of Provider
CAHPS: Access to
Specialists
CAHPS_4 CAHPS: Access to Specialists
CAHPS: Health
Promotion and
Education
CAHPS_5 CAHPS: Health Promotion and Education
CAHPS: Shared
Decision Making
CAHPS_6 CAHPS: Shared Decision Making
CAHPS: Health
Status/Functional
Status
CAHPS_7 CAHPS: Health Status/Functional Status
CAHPS: Stewardship
of Patient Resources
CAHPS_11 CAHPS: Stewardship of Patient Resources
CAHPS: Courteous and
Helpful Office Staff
CAHPS_9 CAHPS: Courteous and Helpful Office Staff
CAHPS: Care
Coordination
CAHPS_8 CAHPS: Care Coordination
Hospital-Wide 30-day
Readmission Rate
Measure_479 Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate
for MIPS Eligible clinician Groups. Risk-adjusted percentage of ACO
assigned beneficiaries who were hospitalized and readmitted to a
hospital within 30 days of discharge from the index hospital admission.
Note that a lower performance rate is indicative of better quality.
All-Cause Unplanned
Admissions for
Patients with Multiple
Chronic Conditions
Measure_484 Clinician and Clinician Group Risk-standardized Hospital Admission
Rates for Patients with Multiple Chronic Conditions. Annual risk-
standardized rate of acute, unplanned hospital admissions among
Medicare Fee-for-Service (FFS) patients aged 65 years and older with
multiple chronic conditions (MCCs). Note that a lower performance
rate is indicative of better quality.
Falls: Screening for
Future Fall Risk
QualityID_318 Percentage of patients 65 years of age and older who were screened
for future fall risk during the measurement period.
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Term Name Variable Name Definition
Preventive Care and
Screening: Influenza
Immunization
QualityID_110 Percentage of patients aged six months and older seen for a visit
between October 1 and March 31 who received an influenza
immunization OR who reported previous receipt of an influenza
immunization.
Preventive Care and
Screening: Tobacco
Use: Screening and
Cessation
Intervention
QualityID_226 Percentage of patients aged 18 years and older who were screened for
tobacco use one or more times within 24 months AND who received
tobacco cessation intervention if identified as a tobacco user.
Preventive Care and
Screening: Screening
for Depression and
Follow-up Plan, WI
QualityID_134_WI Percentage of patients aged 12 years and older screened for
depression on the date of the encounter or 14 days prior to the date of
the encounter using an age appropriate standardized depression
screening tool AND if positive, a follow-up plan is documented on the
date of the eligible encounter.
Preventive Care and
Screening: Screening
for Depression and
Follow-up Plan, eCQM
QualityID_134_eCQM Percentage of patients aged 12 years and older screened for
depression on the date of the encounter or 14 days prior to the date of
the encounter using an age appropriate standardized depression
screening tool AND if positive, a follow-up plan is documented on the
date of the eligible encounter.
Preventive Care and
Screening: Screening
for Depression and
Follow-up Plan, MIPS
CQM
QualityID_134_MIPSCQM Percentage of patients aged 12 years and older screened for
depression on the date of the encounter or 14 days prior to the date of
the encounter using an age appropriate standardized depression
screening tool AND if positive, a follow-up plan is documented on the
date of the eligible encounter.
Colorectal Cancer
Screening
QualityID_113 Percentage of adults 50 - 75 years of age who had appropriate
screening for colorectal cancer.
Breast Cancer
Screening
QualityID_112 Percentage of women 50 - 74 years of age who had a mammogram to
screen for breast cancer in the 27 months prior to the end of the
measurement period.
Statin Therapy for the
Prevention and
Treatment of
Cardiovascular
Disease
QualityID_438 Percentage of the following patients—all considered at high risk of
cardiovascular events—who were prescribed or were on statin therapy
during the measurement period:
· Adults aged ≥ 21 years who were previously diagnosed with or
currently have an active diagnosis of clinical atherosclerotic
cardiovascular disease (ASCVD); OR
· Adults aged ≥ 21 years who have ever had a fasting or direct low-
density lipoprotein cholesterol (LDL-C) level >190 mg/dL or were
previously diagnosed with or currently have a diagnosis of familial or
pure hypercholesterolemia; OR
· Adults aged 40-75 years with a diagnosis of diabetes with a fasting or
direct LDL-C level of 70-189 mg/dL
Depression Remission
at Twelve Months
QualityID_370 Percentage of adolescent patients 12 to 17 years of age and adult
patients 18 years of age or older with major depression or dysthymia
who reached remission 12 months (+/- 60 days) after an index event.
Diabetes: Hemoglobin
A1c (HbA1c) Poor
Control (>9%), WI
QualityID_001_WI Percentage of patients 18 - 75 years of age with diabetes who had
hemoglobin A1c > 9.0% during the measurement period. Note that a
lower performance rate is indicative of better quality.
Diabetes: Hemoglobin
A1c (HbA1c) Poor
Control (>9%), eCQM
QualityID_001_eCQM Percentage of patients 18 - 75 years of age with diabetes who had
hemoglobin A1c > 9.0% during the measurement period. Note that a
lower performance rate is indicative of better quality.
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Term Name Variable Name Definition
Diabetes: Hemoglobin
A1c (HbA1c) Poor
Control (>9%), MIPS
CQM
QualityID_001_MIPSCQM Percentage of patients 18 - 75 years of age with diabetes who had
hemoglobin A1c > 9.0% during the measurement period. Note that a
lower performance rate is indicative of better quality.
Controlling High Blood
Pressure, WI
QualityID_236_WI Percentage of patients 18 - 85 years of age who had a diagnosis of
hypertension overlapping the measurement period and whose most
recent blood pressure was adequately controlled (< 140/90 mmHg)
during the measurement period.
Controlling High Blood
Pressure, eCQM
QualityID_236_eCQM Percentage of patients 18 - 85 years of age who had a diagnosis of
hypertension overlapping the measurement period and whose most
recent blood pressure was adequately controlled (< 140/90 mmHg)
during the measurement period.
Controlling High Blood
Pressure, MIPS CQM
QualityID_236_MIPSCQM Percentage of patients 18 - 85 years of age who had a diagnosis of
hypertension overlapping the measurement period and whose most
recent blood pressure was adequately controlled (< 140/90 mmHg)
during the measurement period.
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Parameters
File year Performance year period
2022 January 1, 2022-December 31, 2022
2021 January 1, 2021-December 31, 2021
2020 January 1, 2020-December 31, 2020
2019A July 1, 2019-December 31, 2019
2019 January 1, 2019-December 31, 2019
2018 January 1, 2018-December 31, 2018
2017 January 1, 2017-December 31, 2017
2016 January 1, 2016-December 31, 2016
2015 January 1, 2015-December 31, 2015
2014 January 1, 2014-December 31, 2014
2013
21-month (April 1, 2012-December 31,
2013) or 18-month (July 1, 2012-
December 31, 2013) period for ACOs
with 2012 start dates, and a 12-month
(January 1, 2013-December 31, 2013)
period for ACOs with 2013 start dates
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Notes
For details on the Medicare
Shared Savings Program, refer to:
Shared Savings Program on CMS.gov
For details on the methodology
used to determine shared savings
and losses, refer to:
Medicare Shared Savings Program Guidance & Specifications
Medicare Shared Savings Program Statutes & Regulations
For details on COVD-19
adjustments, refer to:
Medicare Shared Savings Program Shared Savings and Losses and Assignment Methodology
Specifications of Policies to Address the Public Health Emergency for COVID-19
File year Notes
2022
All performance year expenditure, risk score, and person year variables, and variables related to
savings and loss calculations that are derived from these variables, unless otherwise noted, are
calculated excluding months associated with episodes of care for the treatment of COVID-19
episodes. Please reference the Medicare Shared Savings Program Shared Savings and Losses and
Assignment Methodology Specifications of Policies to Address the Public Health Emergency for
COVID-19.
Months associated with episodes of care for the treatment of COVID-19 have been included in
the calculations for the following variables: Inpatient hospital discharges, Short term hospital
discharges, Long-term hospital discharges, Rehabilitation hospital or unit discharges, Psychiatric
hospital or unit discharges, Outpatient ED visits, Emergency department visits that lead to a
hospitalization, CT events, MRI events, Primary care services, Primary care services with a
primary care physician (PCP), Primary care services with a specialist, Primary care services with a
NP/PA/CNS, Primary care services with a FQHC/RHC, Skilled nursing facility discharges, Skilled
nursing facility length of stay, Skilled nursing facility payment per stay, Percentage Duals, Share
of Long-Term Institutionalized Beneficiaries
The definition for Met the Quality Performance Standard is specific to calendar year 2022.
DisAffQual is equal to 1 for all ACOs as a result of the COVID-19 pandemic which occurred during
the quality reporting period, affecting all U.S. counties and triggering the extreme and
uncontrollable circumstances policy for quality reporting for 2022.
Quality performance rates are displayed with a dash “-” when missing or unreported. If an ACO
reported quality measure performance via both CMS Web Interface measures and eCQMs/MIPS
CQMs, the quality performance rates associated with the reporting option that resulted in a
lower Quality Performance score are displayed as missing.
For PY 2022, the CMS Web Interface measures Quality ID #438 and Quality ID #370 do not have
benchmarks, and therefore, were not scored. CAHPS_7 did not have a benchmark and was not
scored. For PY 2022, the eCQM collection type for Quality ID #236 and Quality ID #134 were
subject to measure suppression for the eCQM collection type, and therefore, these eCQMs do
not have benchmarks. Thus, if these measures were only reported as an eCQM, the measure is
suppressed. If these measures were reported as both an eCQM and a MIPS CQM, the measure is
suppressed for both collection types. If these measures were reported as a MIPS CQM only, the
measure may be included if data completeness and case minimum requirements were met.
CAHPS for MIPS, Quality ID# 321, is a composite measure that includes several summary survey
measures (SSMs); there is no composite performance rate to report for this measure. The
individual CAHPS measures or SSMs that are part of CAHPS for MIPS are CAHPS_1, CAHPS_2,
CAHPS_3, CAHPS_4, CAHPS_5, CAHPS_6, CAHPS_7, CAHPS_8, CAHPS_9, and CAHPS_11.
The CMS cell size suppression policy sets minimum thresholds for the display of CMS data. The
policy stipulates that no cell (e.g., admissions, discharges, patients, services, etc.) containing a
value of 1 to 10 can be reported directly. A value of zero does not violate the minimum cell size
policy. In addition, no cell can be reported that allows a value of 1 to 10 to be derived from
other reported cells or information. For example, the use of percentages or other mathematical
formulas that, in combination with other reported information, result in the display of a cell
containing a value of 1 to 10 are prohibited. As a result, cells in this data set are suppressed with
an “*” if displaying them would violate the CMS cell size suppression policy. For more
information on this policy, refer to
https://www.hhs.gov/guidance/document/cms-cell-
suppression-policy.
