CMS PACE Quality Measures

On Nov. 13 the Centers for Medicare & Medicaid Services (CMS) posted three additional PACE quality measures (Stream 3) for public comment on the CMS Quality Measures website. The project title for these measures is "Development, Implementation, and Maintenance of Quality Measures for the Programs of All-Inclusive Care for the Elderly (PACE)." The Call for Public Comment period opens on Nov. 15, and comments are due to CMS and its contractor, Econometrica, by midnight on Dec. 15.

CMS currently is seeking comments on three additional draft quality measures for PACE:

  • Participant Influenza Immunization,
  • PACE Staff Influenza Immunization, and
  • Participant Emergency Department (ED) Utilization Without Hospitalization.

In addition to general comments on any of these measures, CMS is seeking input on several topics identified during validity testing that are related specifically to the following:

  • definition of reporting influenza season;
  • participant inclusion criteria for the denominator of the Participant Influenza measure;
  • definition of contraindications; and
  • treatment of observation stays in ED Utilization Without Hospitalization measure.

As part of its measure development process, CMS encourages interested parties to submit comments on the proposed measures and the suitability of these measures to the PACE program. Comments received will inform the final technical specifications on the third set of quality measures that CMS plans to implement for PACE programs. For additional information regarding the proposed measure specifications, data collection instructions, and specific instructions for the submission of comments for these potential measures, visit the CMS Quality Measures website.

NPA, with guidance from the Performance Measures Subcommittee of the NPA Quality Committee, will submit a comment letter to CMS and develop a template comment letter for NPA members. To further inform our comment, we encourage you to share the comments of your organization with Mia Phifer, vice president of Quality, by Dec. 1.

If you have any questions, contact Mia Phifer.

Performance Measures Ensure Accountability

The creation of performance measures for PACE programs is imperative to ensure that the programs are accountable to their participants and to demonstrate the value and quality of the PACE model of care. As the federal government and the states continue to focus on integrated care for the dually-eligible population, NPA recognizes the need to develop performance measures to monitor the provision of long-term care services for this population.

NPA is developing a core set of quality measures in collaboration with the Quality Committee. The selection criteria considered for the measures will include the following:

  • High Impact (i.e., high prevalence, high cost, national health priority area);
  • Relevance (to PACE population);
  • Feasibility (i.e., required data that are readily available or could be captured without undue burden); and
  • Usability and Use (for the purposes of quality improvement and accountability).

The performance measures will provide a way to assess the quality of health care and services against recognized standards and allow PACE programs to demonstrate value to payers and consumers and to distinguish the PACE model from similar approaches. The NPA Common Data Set project will enhance the performance measures and explore the development of robust outcome measures.

PACE Quality Leadership Program

Recognizing that PACE professionals have unique challenges and opportunities, NPA developed the Quality Leadership Mentorship Program. The program pairs experienced PACE quality improvement (QI) professionals with new quality leaders. The objective is to foster an exchange of information and experience, allowing for the transmission of guidance and support. Potential mentees can indicate their preference for a mentor from the same CMS region or from a PACE organization similar in census or any other characteristic. All mentors are volunteers working with NPA and the Quality Improvement Committee to strengthen the recognition for quality care in PACE.

Quality Improvement Symposiums

NPA offers QI professionals in PACE two annual dedicated events focused on issues related to quality improvement and compliance. For more information, visit the Education section.

QI Data Analysis and Research

In addition to actively working with the Quality Improvement Committee and CMS leadership on audit and compliance issues, NPA engages in data analysis to identify educational opportunities for QI professionals in PACE. NPA reviews the data collected through DataPACE2 for trends and opportunities to implement PACE-wide quality improvement initiatives. NPA also facilitates collaboration among the Quality Improvement, Primary Care, Research and Education committees to develop projects such as research studies and educational materials.

There are more than 120 PACE programs in 31 states. See how your demographics and service utilization compare with those of your peers.

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