To date, the Ohio Department of Medicaid (ODM), in collaboration with the Governor’s Office of Health Transformation, has designed and launched reporting on 43 episodes of care. Nine of these episodes are currently linked to financial incentives (see links below). In line with ODM’s thresholding methodology, quality metric thresholds for these episodes have been updated for 2018. All quality metrics thresholds are shifted to incentivize continuous improvement in quality and align with the State’s goal of ramping up thresholds to top quartile performance over a five-year time period.
There are other notable changes to quality metric definitions including the following:
- Asthma – The code list defining the asthma controller medication metric has been updated to reflect the latest clinical and coding practices, effective 2017.
- Perinatal – The code list defining the HIV screening rate in the perinatal episode has been updated to reflect latest clinical and coding practices, effective 2017.
- Perinatal – The Group B Streptococcal screening metric will shift from a metric linked to payment to a reporting-only metric, effective 2018.
- Cholecystectomy – The severe adverse outcomes metric code list in cholecystectomy has been updated to more narrowly target severe outcomes as a result of the cholecystectomy, effective 2018.
- All commendable, acceptable, and positive incentive limit thresholds remain constant in 2018.
Following are links to the episode quality metrics and corresponding thresholds for 2018:
- Asthma exacerbation
- COPD exacerbation
- Perinatal
- Cholecystectomy
- Colonoscopy
- Esophagogastroduodenoscopy
- Gastrointestinal bleed
- Upper respiratory infection
- Urinary tract infection.
If you have additional questions, visit the ODM website or contact Monica Juenger or Marjorie Yano.