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CMS Seeking Input From Medicare Plans On Changes to Star Rating Methodology

Wednesday, December 28, 2011

The Centers for Medicare & Medicaid Services Dec. 20 asked Medicare Advantage and prescription drug plans for comments about possible changes to its star rating methodology, including adding new measures, such as for quality improvement.

CMS in a memorandum said it was sending out the planned methodology early to receive input prior to the April 2012 issuance of the 2013 Call Letter to plans.

Under the star rating system, CMS grades plans on a scale of one to five and posts the ratings on the Medicare website for beneficiaries interested in enrolling.

Beginning in 2012, MA plans will begin to receive bonus payments based on the quality ratings.

For example, CMS said that to encourage plan improvement, it is proposing a measure that focuses on whether plans have consistently improved their performance over time, according to the memo, sent to plans by Cynthia Tudor, director of the Medicare Drug Benefit and C & D Data Group.

Contracts With Quality Providers

In addition, to encourage continued high performance, CMS said it expects plans to contract with physicians, hospitals, pharmacy benefit managers, pharmacies, and other providers that are committed to high quality care and services.

“For example, in our proposed methodology for 2013, we include a potential measure of the quality of hospital care that enrollees in a health plan receive,” the memo said.

CMS also said it wants to encourage enrollees to receive coordinated care across their health and drug benefits.

“To that end, we are adding a measure of care coordination for MA contracts and also adding a Part D measure focused on comprehensive medication reviews that are part of the Medication Therapy Management program.”

New Measures Considered

Specifically, two new measures are being considered for Part C, one for Part D, and one for both, including:

  • “Measures from the Hospital Inpatient Quality Reporting program” (Part C). CMS will determine whether it can create an MA contract-level measure of the hospital care that enrollees in each contract receive.
  • “Survey measures of care coordination from the Consumer Assessment of Healthcare Providers and Systems survey” (Part C). This will include questions such as whether the doctor had medical records and other information about the enrollee's care and whether there was followup with the patient to provide test results.
  • “Medication Therapy Management (MTM) program measures related to Comprehensive Medication Reviews” (Part D). This may include measuring the percentage of beneficiaries who receive a completion rate for comprehensive medication review.
  • “A measure of quality improvement” (Parts C and D). This would calculate improvement or decline at the individual measure level, prior to creating a measure of net improvement at the contract level.
Modifications to Methodology

The memo also said that CMS is contemplating modifications to the methodology, such as including information on dismissed appeals in the measure “plan makes timely decision about appeals.”

In another modification example, special needs plans would now be rated on the measure about having foreign language interpreters in call centers, the memo said.

Further, there will be a change in how the interpreter measure will be rated, using the prospective enrollee's phone number.

“The calculation of this measure is the number of successful contacts with the interpreter or TTY/TDD divided by the number of attempted contacts,” the memo said.

“Successful contact with an interpreter will be defined as establishing contact with a translator and either starting or completing survey questions,” it said. “Successful contact with a TTY/TDD service will be defined as establishing contact with a TTY/TDD operator who can answer questions about the plan's Medicare Part C or Part D benefit.”

CMS said it would consider comments received by Jan. 13.


The memo is available at http://op.bna.com/hl.nsf/r?Open=myon-8psrm7.  

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