An Accountable Care Organization (ACO) can be the perfect way for your practice or specialty clinic to enhance patient care while reducing costs and taking advantage of incentive payments for Medicare patients. Participating in an ACO requires careful tracking of applicable quality measures to prove compliance and qualify for such payments.
What is an ACO?
ACOs were conceived as a way to incentivize health care providers to deliver value-based patient care. Today's ACOs can help physicians and hospitals improve patient care standards, establish and utilize electronic health records (EHRs), and receive payment adjustments based on the scoring of multiple measures through various incentive models.
APMs
An Alternative Payment Model (APM) provides added incentive payments to provide high-quality and cost-efficient care. An APM can be applied to a specific clinical condition, an individual care episode or a collective population.
MSSPs
The Medicare Shared Savings Program (MSSP) is an advanced APM, which offers physicians, hospitals and others involved in patient care an opportunity to:
- Promote accountability for a patient population
- Coordinate items and services for Medicare FFS beneficiaries
- Encourage investment in high-quality and efficient services
- Benefit from incentives offered along several different tracks
MSSPs allow groups of health care providers to create ACOs and earn incentives for value-based care.
Clinically Integrated Networks (CINs)
A CIN is a platform created by a physician group to achieve any number of goals, and can be connected to multiple contracts. A CIN can provide the underlying framework for an ACO, which is typically limited to a contract with the Centers for Medicare & Medicaid Services (CMS.) Not all CINs are ACOs, but all ACOs can be considered CINs.
ACO reporting methods and requirements
CMS requires ACOs to report Quality measures to calculate incentives (or penalties.) The method of reporting is in a current state of changeover.
CMS vs. APP
Historically, ACOs have reported Quality measures through the CMS Web Interface, but this availability will end after the 2021 performance period, as a changeover is made to the APM Performance Pathway (APP). Quality measures reporting in 2022 must be done through APP via a registry or EHR.
MSSP vs MIPS
MIPS (Merit-Based Incentive Payment System), CMS's largest value-based care payment program, is mandatory for all providers who meet all of the following criteria:
- Receive $90,000 in Medicare part B payments
- Provide care for more than 200 Part B-enrolled Medicare beneficiaries
- Bill more than 200 professional services per year.
For ACOs that don't meet the criteria, participating in MSSP is still possible. Incentive payments for MSSP tend to be somewhat lower than total potential incentives from MIPS.
ACO quality measures
Under MIPS, performance is assessed across four performance categories:
- Quality
- Cost
- Improvement activities
- Promoting interoperability
Quality measures are further split into four categories:
- Patient/caregiver experience
- Care coordination/patient safety
- Preventive health
- At-risk populations
Your ACO can select six specific quality measures (out of dozens) that apply specifically to your practice. Surfacing the best measures to report on is critical to achieving the best performance possible.
Using Tangible for ACO quality reporting
Tangible and Happe Analytics can help your ACO achieve optimal reporting and the best possible MSSP or MIPs scores to achieve the highest possible positive adjustment to your Medicare revenues.
Our data analytics can identify which populations, procedures, and episodes are seen most often at your practice, enabling you to choose the measures to report on that are most likely to yield positive results.
We also help you utilize your EHR to the fullest possible extent in compliance with the upcoming changes in ACO reporting. The result is a streamlined system that motivates your physicians to participate fully and puts you on the path to Exceptional Performance in your reporting.
