A POPULATION HEALTH MANAGEMENT COMPANY

ACO

Accountable Care Organizations (ACOs) are groups of healthcare professionals who team up to give coordinated, high quality care to the Medicare patients they serve. The Medicare Shared Savings Program allows successful ACOs to share in the savings they achieve for the Medicare program. Physician-based and rural providers may be selected to receive upfront and monthly payments to invest into their care coordination infrastructure through the Advanced Payment ACO Model.

2015 Reporting:

  • 33 quality measures across 4 quality domains
  • Reported through a combination of CMS claims and administrative data, a database designed for practice or ACO-level clinical quality measure reporting, and a patient experience of care survey

CQMs:

  • Pioneer ACOs and Shared Savings Program ACOs will use the Web Interface, which contains a database pre-populated with select quality measure information for a sample of the ACO’s beneficiaries.
    • ReportingMD can provide a data collection tool for collecting and submitting data to CMS

If the ACO fails to successfully report on quality measures, all groups and solo practitioners under the ACO will be subject to the automatic downward adjustment:

  • 2% PQRS penalty
  • 4% VBM penalty (2% for groups under 10 EPs)

Groups and solo practitioners participating in an ACO under the Shared Savings Program in the CY 2015 performance period will have their Value Modifier calculated as follows for the CY 2017 payment adjustment period:

  • The Cost Composite for the VBM will be set to average
  • The Quality Composite will be based on the ACO’s quality data reported

Physician solo practitioners and physician groups in which at least one eligible professional participates in the Pioneer ACO Model or CPC Initiative in 2015 will have their Value Modifier calculated as follows for 2017:

  • Cost Composite: Average
  • Quality Composite: Average

Solo practitioners and groups in which at least one eligible professional participates in the Pioneer ACO Model or CPC Initiative in 2015 will be classified as Category 1 and will not be subject to the VBM downward adjustment for CY 2017.

CMS.gov, Quality Measures and Standards