BPCI Advanced: Quality Measures

Background

The Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model includes a Quality component that prioritizes the patient experience in the Model. The quality measures that the Model selected cover the spectrum of pre to post-episode care, and are aggregated into a Composite Quality Score (CQS) for Model Participants.

The CMS Innovation Center has engaged extensively with stakeholders to identify more targeted and actionable quality measures that better reflect performance within Clinical Episodes. In doing so, the Center intends to provide Participants the flexibility to report quality measure performance through either an Administrative Quality Measures Set. BPCI Advanced Model's strategy towards Quality, and the various quality measure options available to participants, are summarized in the Quality Measures Overview Infographic (June 2023) (PDF).

Please note: On March 27, 2023, Battelle was contracted by the Centers for Medicare & Medicaid Services (CMS) to replace the National Quality Forum (NQF) as the Consensus-Based Entity (CBE) for quality measure endorsement and maintenance processes. Our Quality Measure Fact Sheets starting in Model Year 7, will have the NQF number and the CMS Measures Inventory Tool (CMIT) ID to support Participants in identifying the quality measure and understand how the measure is calculated.

Administrative Quality Measures Set

The Administrative Quality Measures Set, introduced at the start of the Model, contains six exclusively claims-based measures directly collected by CMS. Two measures, All-cause Hospital Readmission and Advance Care Plan will be required for all Clinical Episodes, and up to two additional measures may apply to each Clinical Episode.

Alternate Quality Measures Set

The Alternate Quality Measures Set, introduced in Model Year 4, includes a combination of up to five claims-based, hospital-based, and registry-based measures for each Clinical Episode. The Alternate Quality Measures Set was developed after CMS gathered information from various stakeholders and professional healthcare societies to identify a set of tailored quality measures that align with each of the specialty-specific Clinical Episodes in the Model.

Two measures, All-cause Hospital Readmission and Advance Care Plan apply to all Clinical Episodes, and up to three additional measures may apply to each Clinical Episode.

Quality Measures Set Selection

Each Episode Initiator will be required to commit to either the Administrative Quality Measures Set or the Alternate Quality Measures Set for each Clinical Episode in advance of participation at the beginning of each Model Year. The established CQS calculation methodology will apply to both measure sets.

CMS may determine whether additional quality measures should be incorporated into the Administrative Quality Measures Set or the Alternate Quality Measures Set in future Model Years, and the quality measures may be updated by CMS on an annual basis.

Additional Information and Resources

Quality Measures Questions & Answers

• Quality Measures Questions and Answers (August 2023) (PDF) - updated August 2023
• Discontinued HCPCS Codes Quality Measures Questions and Answers (March 2023) (PDF)

Quality Methodology Webcast

• Webcast: Introduction to Quality Measures Webcast (August, 2023) - Recording (MP4)  |  Slides (PDF)  |  Transcript (PDF)
• Webcast: Composite Quality Score MY3 – Audio (link) | Slides (PDF) | Transcript (PDF)

Clinical Episode to Quality Measures Correlation Tables

• Clinical Episodes to Quality Measures Correlation Table - MY7 (PDF)
• Clinical Episodes to Quality Measures Correlation Table – MY6 (PDF) - updated as of August 2023
• Clinical Episodes to Quality Measures Correlation Table – MY5 (PDF) - updated August 2023
• Clinical Episodes to Quality Measures Correlation Table - MY4 (PDF)
• Clinical Episodes to Quality Measures Correlation Table - MY3 (PDF)

Quality Measures Fact Sheets

Model Year 7 Quality Measure Fact Sheets

• MY7 Administrative Fact Sheet Package (PDF)
• MY7 Alternate Fact Sheet Package (PDF)

Model Year 6 Quality Measure Fact Sheets

• MY6 Administrative Fact Sheet Package (PDF) - updated as of August 2023
• MY6 Alternate Fact Sheet Package (PDF) – updated as of March 2023

Model Year 5 Quality Measure Fact Sheets

• MY5 Administrative Fact Sheet Package (PDF) – updated August 2023
• MY5 Alternate Fact Sheet Package (PDF) – updated September 2023

Model Year 4 Quality Measure Fact Sheets

• MY4 Administrative Fact Sheet Package (PDF) – updated as of September 2021
• MY4 Alternate Fact Sheet Package (PDF) – updated as of March 2022

Model Year 1, 2, and 3 Administrative Quality Measure Fact Sheets

• MY3 Advanced Care Plan - NQF #0326 (PDF)
• MY3 All-cause Hospital Readmission Measure - NQF #1789 (PDF)
• MY3 Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction - NQF #2881 (PDF)
• MY3 Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Coronary Artery Bypass Graft Surgery - NQF #2558 (PDF)
• MY3 Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) - NQF #1550 (PDF)
• MY3 Perioperative Care: Selection of Prophylactic Antibiotic: First or Second Generation Cephalosporin - NQF #0268 (PDF)
• MY3 CMS PSI 90 - CMS Patient Safety Indicators (PDF)

Participant Resources

Please visit the Participant Resources web page for additional materials for organizations actively participating in the Model.

General Information

Please visit the Additional Resources section on the General Information page for additional materials about the Model.