CMS Releases Advance Notice of Changes for Calendar Year 2016
Plan now for key changes in Star Ratings measures
In late February 2015, the Centers for Medicare and Medicaid Services (CMS) released an advance notice of proposed changes that will impact the services you provide and your pharmacy’s clinical performance measures. Click here to view the original 2016 Advance Notice from CMS. After a period of public comment, CMS will release a final version of the changes.
Here is a short summary of three key changes for the 2016 plan year.
Three Key Planned Changes to the Star Ratings Measures That Will Impact Pharmacy Performance
Here’s a summary of the major proposed changes that will be finalized in the April CMS Final Call Letter.
Comprehensive Medications Review (CMR) Full Measure for 2016
For 2016, the measure will based on the PQA-endorsed completion rate for CMRs, and proposed measurement will move from display to the full measure.
- Focus on completing any available CMR opportunities.Because plans’ 2016 rating will be based on 2014 data, your CMR performance for 2014 and 2015 matter!
- Continue to emphasize the Adherence and High-Risk Medication (HRM) measures.The CMR measure will have less of an overall impact for plans, as it has an assigned weight of 1, versus the triple weighting of current adherence and HRM measures you are focusing on today.
Diabetes Treatment Measure Proposed for Retirement for 2017 Star Ratings
- Consider shifting your focus to other performance measures now,because your 2015 diabetes treatment performance won’t “count.” CMS proposes to retain the measure for the 2016 Star Ratings, which is based on 2014 data, and then remove it from the 2017 ratings.
- Treatment of hypertension in patients with diabetes (and renal protection) is still very important clinically.However, due to revised 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults (JNC-8 treatment guidelines), additional medications, such as calcium-channel blockers and thiazide diuretics, are considered first-line care for some patients. When the Pharmacy Quality Alliance (PQA) retested the measure with the additional medications included, treatment scores exceeded the 90th percentile, leaving little room for improvement. Rather than revise the diabetes measure to include additional classes, PQA and now CMS have recommended it for retirement so that plans and providers can focus on other measures where improved quality can benefit more patients.
Statin Use in Persons with Diabetes Anticipated as 2017 Display Measure
- Your experience addressing the diabetes treatment measure has prepared you to focus on other gaps in care,such as a new Statin Use in Diabetes measure that was endorsed by PQA last year. PQA developed a new measure, Statin Use in Persons with Diabetes, to support American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommending statin therapy for primary prevention for patients 40–75 years of age with diabetes. CMS will continue to test this measure, and the measure could be considered as a new 2017 Display Measure (based on 2015 data) and a 2018 Star Rating (based on 2016 data).
- Visit CMS.gov for more information on Medicare Advantage rates and statistics.
- Visit the Driving Pharmacy Performance Education Center sponsored by Health Mart for additional guides, continuing education, and articles.