In 2011, as healthcare costs continued to rise, The Department of Health and Human services sought out a solution. The goal was not only to control the cost of care, but to improve overall quality of care, to increase care coordination, and to focus on preventative care. Accountable Care Organizations (ACOs) were born.
By the end of January 2016 there were 838 ACOs operating across all fifty states and Washington DC. Today ACOs are paid under different models and considered part of different tracks; most commonly the Track 1 Medicare Shared Savings Program (MSSP) model, but also Track 2 and Track 3 programs such as Next Generation ACOs and Pioneer ACOs. According to CMS, 95% of all ACO’s are considered a Track 1 ACO.
In 2017, MACRA changes ACO classifications slightly. ACOs who meet all the qualifications and achieve the required thresholds will be classified as Advanced Alternative Payment Methods (APMs) and thus won’t be subject to the Merit-Based Incentive Payment System (MIPS). For these ACOs there is a 5% bonus incentive available in addition to incentives they are already receiving. It is important to note that ACOs eligible for Advanced APM status make up only a small part of ACOs. All Track 1 ACOs, meaning 95% of all ACOs, are not eligible for Advanced APM status. In other words, 95% of ACOs must report through MIPS. It will be imperative for these ACOs to work continuously to optimize their MIPS Composite Performance Score (CPS) to maximize their Medicare reimbursements.
ACOs have already begun great work in the areas CMS wants providers to focus on under MIPS: leveraging technology, coordinating care, and lowering costs. But to truly succeed under MIPS, all Eligible Clinicians, ACOs, and/or ACO members must focus on how to optimize their MIPS CPS to maximize their reimbursements under MACRA.
Tracking Quality Data and reporting requirements for ACOs and their members is time consuming and challenging. In most cases, ACO members have a responsibility to submit Quality Data to the ACO. To save time and money, ACO member organizations should look for a solution that can automate the compliance process and provide easy to use, continuous quality data analytics. MIPS puts an increased emphasis on benchmarking and tracking the provider’s performance relative to their peers across ACO quality measures. Some Certified EHR Technologies (CEHRTs) differ from a Certified EHR. A Certified EHR is an input system that maintains your patient and visit data. CEHRTs like Health eFilings on the other hand, are “outputs”; they integrate directly with an organization’s EHR to automatically extract data without requiring any resources from the organization. Because CMS wants providers to leverage technology effectively to improve outcomes, providers using CEHRTs like Health eFilings receive automatic bonus towards their MIPS CPS. Putting the bonus aside, when ACOs have a tool at their disposable to enable drilldown capability from the organization to the provider to the patient level, changes can be made to ensure continuous improvement throughout the year – continuously improving outcomes for patients.
Not all CEHRTs are created equally. Health eFilings helps ensure that organizations not only improve their MIPS CPS and meet their goals in regards to outcomes, costs, etc, but also ensures minimal, if any, work on the administrative side.
MACRA and MIPS have shifted the healthcare industry from a fee-for-service model to a pay-for-performance model. ACOs pioneered this shift, but now the programs go further. ACO member organizations don’t have to work alone – Health eFilings can help ensure continued success and, give access to the data analytics to make improvements, and therefore maximize Medicare reimbursements.