Is there any Quality Performance Standard for ACO Reporting?
The role of accountable care organizations (ACOs) has been made very clear since their formation. They are basically the groups of providers that collectively work for population health management. Throughout their course of serving patients, they strive hard to improve patient care while reducing the cost of care. Just like MIPS reporting for providers, CMS has another path, called ACO reporting for all Medicare ACOs. They collect the data as per the applicable measure and forward it to CMS. Every year, CMS examines this data and checks whether an ACO is doing well or not. Afterward, it decides their qualification or eligibility for shared savings payments.
However, current updates for Medicare ACO
providers show that their reporting requirements are soon going to change.
Probably by 2025, CMS is planning to do so. We can say that CMS has completed
the multi-year transition period for updating ACO reporting requirements. The
primary motive for doing so still empowers the main motto of the ACO
establishment. Here, any qualified registries like P3 Care may hold your back,
keeping you one step ahead of others.
Before further delay, let's just hang on
to the details regarding the changes ahead in ACO reporting. Additionally, we
will see the quality performance standards for ACOs.
Expiry of the CMS Web Interface is Final Now
The CMS Web Interface has been a
convenient option for data collection in MIPS and ACO reporting. But right now,
CMS has made its decision to exclude this collection type very clear. Even for
MIPS 2023 reporting, the option is no longer available to participants.
However, for some reason, CMS is avoiding the hustle in ACO Medicare reporting.
So, for now, ACOs have two subsequent phases from 2021 to 2025.
➔
The first phase will
last from 2021 to 2024.The ACOs will have two go-to-action options during this
duration.
◆
Either report data for
10 CMS Web Interface measures;
◆
Or submit data to the
three all-payer eCQMs/MIPS CQMs.
All ACOs will administer the CAHPS for
the MIPS survey and get scores on two administrative claims-based measures
(determined by CMS) as part of the APP.
➔
The next phase will
begin in 2025. The ACOs will also say goodbye to the CMS web interface at this
time. All they will be left with is submitting data to the three all-payer
eCQMs/MIPS CQMs. Along with this, they have to administer the CAHPS for the
MIPS survey. Utilizing administrative claims data, CMS will compute two
measures.
New Quality Performance Standard for ACO Reporting
As we can observe, CMS has guided the
providers at every stage of their ACO reporting. Likewise, CMS has now
encouraged ACOs to compete for their share of savings and avoid the maximum
shared losses. This approach will eventually toughen the ACO reporting ground
for the ACOs. Moverover, the federal government has set specific criteria for
MSSP ACOs to fulfill every year. These criteria vary a little bit from one year
to another. Thus, it allows a gradual phase in the improved level of quality
performance.
ACO Shared Savings and Losses
Criteria for PY 2022
➔
meets the 30th
percentile of all MIPS quality performance category scores; or
➔
Reports the three
eCQMs/MIPS CQMs (meeting data completeness and case minimum requirements) and
achieves the following scores:
◆
a score below the 10th
percentile on at least one outcome measure;
◆
a score below the 30th
percentile on at least one of the remaining five measures.
➔
Meets the 30th
percentile of all MIPS quality performance category scores; or
➔
Reports the three
eCQMs/MIPS CQMs (meeting data completeness and case minimum requirements) and
achieves the following scores:
◆
a score below the 10th
percentile on at least one outcome measure;
◆
a score below the 30th
percentile on at least one of the remaining five measures.
➔
What if an ACO does not
achieve either of the aforementioned requirements? However, they satisfy the
alternative quality performance criteria by attaining a quality performance
score that is at or above the performance benchmark's 10th percentile on at
least one of the outcome measures. In this case, they will be eligible for a
reduced scaled rate of savings.
➔
Meets the 40th
percentile of all MIPS quality performance category scores; or
➔
Reports the three
eCQMs/MIPS CQMs (meeting data completeness and case minimum requirements) and
achieves the following scores:
◆ a score below the 10th percentile on at least one outcome measure;
◆ a score below the 30th percentile on at least one of the remaining
five measures.
➔
What if an ACO does not
achieve either of the aforementioned requirements? However, they satisfy the
alternative quality performance criteria by attaining a quality performance
score that is at or above the performance benchmark's 10th percentile on at
least one of the outcome measures. In this case, they will be eligible for a
reduced scaled rate of savings.
ACO Shared Savings and Losses
Criteria for PY 2025
ACOs will be considered to have met the
quality performance requirement for 2025 and subsequent years if one of the
following conditions is met:
➔
Achieves a score in the
40th percentile across all MIPS quality performance category scores;
➔
What if an ACO does not
achieve either of the aforementioned requirements? However, they satisfy the
alternative quality performance criteria by attaining a quality performance
score that is at or above the performance benchmark's 10th percentile on at
least one of the outcome measures. In this case, they will be eligible for a
reduced scaled rate of savings.
What if ACOs Only Administer a
CAHPS Survey?
It is a special condition when an ACO
only administers a CAHPS survey every year. In other words, they do not report
the following:
●
The CMS Web Interface
measure set
●
Three eCQMs/MIPS CQMs in
2023 or 2024
●
Three eCQMs/MIPS CQMs in
2025
This situation is very simple. According
to the new rules for ACO reporting, they will not meet the quality performance
standard or the alternative performance standard.
Conclusion
ACO reporting is a framework for the
performance evaluation of Medicare ACOs. By doing so, the CMS essentially
checks the quality and cost of patient care. Afterward, ACOs receive shared
savings payments when they meet program objectives. CMS has a bigger plan for
the future of ACO reporting. Thereby, we can see how gradually it has
encouraged the providers to attach their TINs to any ACO organization. It will
be very difficult for providers to perform well at times with a changing rule
set. Therefore, P3 Care has offered its valued ACO consulting services to
assist the providers.
Read our previous blog: How Credentialing Affects the Revenue Cycle for Hospital-Based Physicians
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What are the established Quality Performance Standards for ACO Reporting?
ReplyDeleteThe established Quality Performance Standards for ACO reporting encompass patient experience, clinical quality measures, patient safety, care coordination, population health management, and utilization and cost efficiency. These standards assess various aspects of care delivery, aiming to ensure high-quality, patient-centered, and cost-effective healthcare within the accountable care organization framework.
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