CMS Proposed Changes for ACO Reporting 2021

From the next performance year (2021), Accountable Care Organizations (ACOs) expect different reporting requirements under the Medicare Shared Savings Program.

CMS (Centers for Medicare and Medicaid Services) has recommended changes for ACO reporting criteria. The requirements are somewhat the same as for QPP MIPS.

The purpose of the new proposed rules is to lower down the administrative burden of ACOs and to improve the quality of patients’ outcomes.

In light of the expected changes, ACOs can partner up with MIPS Qualified Registries to share their load and meet the reporting requirements efficiently.

CMS Is Eliminating Its Web Interface

The QPP MIPS data submission method, CMS will eliminate Web Interface starting from the next PY 2021.

This MIPS data submission method will no longer be available even for QPP MIPS (Quality Payment Program – Merit-based Incentive Payment System) and (Shared Savings Program) SSP reporting.

The Alternative Reporting Method

Instead of the regular reporting via CMS Web Interface, ACOs will now report data via a new APM Performance Pathway (APP).

All of these rules are proposed in order to include ACOs in the MIPS Value Pathways (MVPs).

Eligible clinicians submitting quality measures via the new APP do not have to submit them again for the QPP MIPS Quality category.

The administrative load for data collection and submission will reduce significantly for both SSP and QPP MIPS reporting processes. Moreover, we can expect improved quality care for Medicare patients as an outcome.

Compact MIPS Quality Measure Set

There is one good news for ACOs that will take effect from next year. They have to report only six measures in total (previously twenty-three measures).

The subcategories include:

1 Diabetes: Hemoglobin A1c (HbA1c) Poor Control
#134 Preventive Care and Screening: Screening for Depression and Follow-up Plan
#236 Controlling High Blood Pressure
#321 CAHPS for MIPS Survey
Hospital-Wide, for 30 days; All-Cause Unplanned Readmission (HWR) (administrative claims)
Rate Risk Standardized; All-Cause Unplanned Admissions for Multiple Chronic Conditions for ACOs (administrative claims)

Score Assessment

ACOs can receive from 3 to 10 points against each measure.

However, points will be rewarded only when the data meets the data completeness rule and the performance threshold.

It is also to keep in mind that the performance threshold for eligible clinicians participating in the SSP has been raised. At least forty percent of the score or more than thirty percent is required for each performance category to earn the incentive and to avoid penalty.

It is indeed a great step towards the progressive and value-based healthcare system.

Quality of Care by ACOs

The idea behind ACOs is to improve the quality of healthcare with collective efforts.

A volunteer group of clinicians, healthcare providers, and hospitals come together to improve care standards for their Medicare patients. The coordinated efforts compensate for the shortcomings that they have to face individually while enhancing patient satisfaction.

Apart from the other changes, several data submission methods will be available for them.

They have the option to submit quality data to CMS for QPP MIPS or SSP as:

ACO by participating under the same TIN (Tax Identification Number), or
Individual clinicians

Data Submission Methods

ACOs can also choose to report via several methods as:

Directly
Via login and upload
A third-party intermediary such as MIPS Qualified Registry

Advantages of Submitting Data to CMS via MIPS Qualified Registry

It is always easy to hire a third-party intermediary to not lose the essence of the program in between the administrative burden. These intermediaries cater to the entire load, comprehend details of your specialty, segment data as per the CMS rules, and timely submit it to authorities.

Accurate Data Compilation

Most organizations still use different platforms to collect different types of data. A MIPS Qualified Registry caters to all such reporting challenges efficiently.

For Instance, they have the resources to collect data effectively and aggregate it as per the reporting requirements for accurate data submission.

Analyze Your Performance

The technology help solves half the problem for QPP MIPS data submission or SSP. Seeking a third-party intermediary helps you optimize, plan, and analyze your performance record.

For Instance, if you get in touch with P3Care, our specialist helps you gauge your performance via data analysis, so you improve your score by adjusting changes in the delivery of care services.

It allows ACOs to refocus on points that are limiting their high score.

Quality Data Reporting to CMS

The more accurately you submit data to CMS, the more chances you have to score high and target incentives and bonuses.

It all comes down to the expertise of the third-party intermediary that if they have resources to cater to the administrative load. Eligible clinicians or ACOs should choose a registry that has the experience to deal with all physician types, i.e. individuals, and groups respectively.

Another factor is the training of resources to cater to the administrative data. With a qualified team at your disposal, you have access to techniques that work reliably to help you avoid penalties.

Conclusion

CMS has offered several data submission options for the ACOs. Now, it is up to them to start planning their incentive payment model participation soon such as for QPP MIPS to maximize their performance.

Another update is also expected later this year. So, maybe there are further changes that we have to work upon.

However, the best approach is to consult a MIPS Qualified Registry as P3Care for the submission process.

We are using a QPP JSON file upload and API submission method for reporting the data to Medicare. Our process is efficient and complies with all quality reporting requirements.

For more information on ACO reporting, contact our MIPS consultants.