Explanation of Appropriate Care Measure (ACM)

The ACM is a composite score that captures whether or not a patient received all the care he or she was eligible to receive. The ACM score is a measure of how often the hospital gets it right.

For Inpatient Prospective Payment (IPPS) hospitals, the ACM will be based on the 27-indicator (7 AMI, 4 HF, 6 PNE and 10 SCIP indicators) set as described in the Reporting Hospital Quality Data Annual Payment Update (RHQDAPU) program for FY 2011. CMS implemented the RHQDAPU program in accordance with section 501(b) of the Medicare Prescription Durg, Improvement and Modernization Act of 2003.

For IPPS hospitals, all patients eligible for care in at least one of the 27 indicators are counted in the denominator. The patients receiving all the care they are eligible for are counted in the numerator.

For Critical Access Hospitals, the ACM will be based on a 10-indicator set (4 HF and 6 PNE). All patients eligible for care in at least one of the 10 indicators are counted in the denominator. The patients receiving all the care they are eligible for are counted in the numerator.

Calculation of the ACM at the patient level: 

The ACM is calculated for only one clinical topic per patient. For example, an AMI patient with chronic heart failure and a principal diagnosis at discharge of AMI would have an ACM based on the AMI indicators.

AMI Example

A non-smoking patient was eligible for aspirin and beta blocker at arrival and for fibrinolytic therapy, but was excluded from aspirin and beta blocker at discharge, ACEI/ARB for LVSD and from PCI. If the patient

• receives aspirin at arrival only – fails ACM
• receives beta blocker at arrival only – fails ACM
• receives both aspirin and beta blocker at arrival and receives fibrinolysis 45 minutes after hospital arrival – fails ACM
• receives both aspirin and beta blocker at arrival and receives fibrinolysis in less than 30 minutes after hospital arrival – passes ACM

Credit is only given if the patient received care for all of the indicators they were eligible for.

Calculation of the ACM at the hospital level:

In the example below, a hospital had 5 AMI patients, 10 HF patients, 10 PNE patients and 5 SCIP patients. The ACM rate, both total and for each clinical topic, is calculated with the numerator made up of patients meeting ACM criteria and the denominator being total patients.

Example