Essential Updates on CMS Proposed Changes for ACO Reporting in 2021

Changes to ACO Reporting Requirements for 2021

New Reporting Criteria Under the Medicare Shared Savings Program

Starting in 2021, Accountable Care Organizations (ACOs) will face new reporting requirements under the Medicare Shared Savings Program (MSSP). The Centers for Medicare and Medicaid Services (CMS) has proposed modifications to the reporting criteria for ACOs, aligning them closely with the Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS). These changes aim to reduce administrative burdens on ACOs while enhancing patient care quality.

Collaboration with MIPS Qualified Registries

In response to the forthcoming changes, ACOs may consider partnering with MIPS Qualified Registries. This collaboration can help streamline the reporting process, making it more manageable and efficient.

Elimination of the Web Interface

Changes to the QPP MIPS Data Submission Method

Beginning in the performance year 2021, CMS will discontinue the Web Interface as a method for submitting QPP MIPS data. This means that it will no longer be available for both QPP MIPS and Shared Savings Program (SSP) reporting.

The Alternative Reporting Method

Introduction of the APM Performance Pathway (APP)

Instead of utilizing the Web Interface, ACOs will transition to the new APM Performance Pathway (APP) for data reporting. This shift is part of the initiative to integrate ACOs into the MIPS Value Pathways (MVPs). Notably, eligible clinicians submitting quality measures through the APP will not need to submit them again for the QPP MIPS Quality category, significantly reducing the data collection and submission workload.

Compact MIPS Quality Measure Set

Reduction in Reporting Measures

A positive change for ACOs is the reduction in reporting measures. Starting next year, ACOs will only need to report six measures, down from the previous twenty-three. The required measures include:

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

Scoring and Performance Thresholds

ACOs will receive a score ranging from 3 to 10 points for each measure, contingent upon meeting the data completeness rule and performance thresholds. It is important to note that the performance threshold for eligible clinicians in the SSP has been raised, requiring at least 40% of the score or more than 30% in each performance category to qualify for incentives and avoid penalties.

Enhancing Quality of Care Through ACOs

The Purpose of ACOs

The concept of ACOs revolves around improving healthcare quality through collaborative efforts. A volunteer group of clinicians, healthcare providers, and hospitals work together to elevate care standards for Medicare patients, addressing individual shortcomings and enhancing patient satisfaction.

Data Submission Methods for ACOs

ACOs have various options for reporting quality data to CMS under QPP MIPS or SSP, including:

– Reporting as an ACO under the same Tax Identification Number (TIN)
– Individual clinician reporting

Reporting Options Available to ACOs

ACOs can choose from several data submission methods, such as:

– Direct reporting
– Logging in and uploading data
– Utilizing a third-party intermediary like a MIPS Qualified Registry

Benefits of Using a MIPS Qualified Registry

Streamlining Data Submission

Engaging a third-party intermediary can alleviate the administrative burdens associated with ACO reporting. These intermediaries understand the complexities of various specialties, segment data according to CMS regulations, and ensure timely submissions.

Accurate Data Compilation

Many organizations face challenges in collecting diverse data types. A MIPS Qualified Registry can effectively manage these reporting demands, ensuring compliance with requirements for accurate data submission.

Performance Analysis

Utilizing technology can simplify the QPP MIPS data submission or SSP process. Partnering with a third-party intermediary allows ACOs to analyze and optimize their performance records. For instance, collaborating with specialists can help ACOs identify areas for improvement in care delivery to enhance scores.

Quality Data Reporting to CMS

Accurate data submission to CMS increases the likelihood of achieving high scores, incentives, and bonuses. The expertise of the chosen third-party intermediary is crucial in managing the administrative workload and ensuring compliance with reporting standards.

Conclusion

CMS has introduced several data submission options for ACOs, making it essential for them to plan their participation in incentive payment models like QPP MIPS to maximize performance. Additional updates are anticipated later this year, suggesting further changes may be on the horizon.

To navigate these changes effectively, consulting a MIPS Qualified Registry, such as P3Care, is advisable. Our efficient QPP JSON file upload and API submission methods ensure compliance with all quality reporting requirements. For more information on ACO reporting, please contact our MIPS consultants.