The Centers for Medicare & Medicaid Services (CMS) added two new quality measures to Medicare's Five-Star Quality Rating Program (Stars Program) for 2022:
- Follow-Up After Emergency Department Visit for People with Multiple Conditions
- Transitions of Care
Follow-Up After Emergency Department Visit for People with Multiple Conditions. Members with two or more chronic conditions, as defined by CMS, should be seen after an emergency room visit within seven days of discharge through an in-person, telephonic, or telehealth visit.
Transitions of Care. This measure evaluates the percentage of members who are 18 and older that were recently discharged and had the following actions completed by a provider:
- Notification of a member's inpatient admission (admission reflected in members' chart within two days of admission)
- Receipt of discharge information (discharge reflected in members' chart within two days of discharge)
- Patient Engagement after inpatient discharge (in-person or telemedicine visit within 30 days of discharge)
- Medication reconciliation post-discharge (in-person or telemedicine medication reconciliation within 30 days of discharge)
Closing care gaps
The Attributed Member Snapshot and Gaps in Care reports, found in the Analytics & Reporting (AR) application of the Provider Engagement, Analytic & Reporting (PEAR) portal, will be updated in May to include members who have not met the measure requirements.
Review the Gap Closure Guide, which can be found in the Analytics & Reporting section of the PEAR Help Center to familiarize yourself with the specifics of the measures. This will help you prepare to close any open gaps noted on the reports or identify any members who may not meet the measure requirements.