My FTI colleagues Mark Van Ert and Krunal Patel summarize among the new high quality measures that can be included into the 2025 CMS Star Scores which can be used to judge Medicare Benefit (MA) plans. The CMS Star Scores are crucial as CMS funds to MA plans is anticipated to extend by 3.7% or $16 billion between 2024 and 2025.
Van Ert and Patel describe the CMS rankings cycle as follows:
Star rankings are decided via a four-year course of. The primary yr is the measurement yr (“MY”), by which plans gather efficiency knowledge for numerous measures, although particular timing can fluctuate — as an illustration, Client Evaluation of Healthcare Suppliers and Programs (“CAHPS”) surveys are performed at first of the second yr. Through the second yr — the reporting yr (“RY”) — the CMS evaluates the earlier yr’s efficiency knowledge. The third yr is the Star 12 months (“SY”), which is when the Star Scores are formally assigned. Within the fourth yr — the standard bonus fee (“QBP”) yr.4
That are the brand new measures to be included for 2025? These embrace:
- Concurrent Use of Opioids and Benzodiazepines. Evaluates the simultaneous prescription of opioids and benzodiazepines, which considerably will increase the chance of respiratory despair and deadly overdoses
- Use of A number of Anticholinergic Drugs in Older Adults. Measure focuses on the dangers related to older adults taking a number of anticholinergic medicines concurrently, which may result in cognitive decline.
- Kidney Well being for Sufferers with Diabetes. Measures the proportion of members aged 18-85 with diabetes (sort 1 and sort 2) who obtained a kidney well being analysis, which incorporates evaluations of estimated glomerular filtration price (eGFR) and a urine albumin-creatinine ratio (uACR).
- Enhancing/Sustaining Bodily Well being. Measures general bodily functioning primarily based on the Medicare Well being Outcomes Survey.
- Enhancing/Sustaining Psychological Well being. Evaluates self-reported beneficiary knowledge relating to emotional well-being, such because the frequency of emotions of despair, nervousness and different psychological well being situations primarily based on the Medicare Well being Outcomes Survey.
Full technical specs of all CMS Star Ranking high quality measures might be discovered right here.