2021 Change that Affects Visibility of Shared Savings Attainment Potential

The new APM Performance Pathway (APP) for Shared Savings Program Accountable Care Organizations was finalized in the Calendar Year 2021 CMS Final Rule and has brought with it many changes that impact various Alternative Payment Models (APMs) with the Medicare Shared Savings Program (MSSP) being no exception. While the final rule extended the highly contested plan to remove the CMS Web Interface reporting option for 2021 MSSP quality measure reporting (2021 only), there have been other significant changes that did go through that MSSP ACOs may or may not be aware of.

Before we get into the heart of these changes, it is important to understand the definition of the “quality performance standard” for MSSP ACOs and its significance in determining shared savings and losses under the MSSP. The ‘quality performance standard’ is the overall standard that the ACO must meet for a performance year to be able to share in the max amount of savings based on the ACO’s track under the program, up to the performance payment limit. Additionally, under certain MSSP tracks, the quality performance standard has an impact on an ACO’s ability to avoid the maximum shared losses possible.

In the 2020 calendar year, the quality performance standard determined if an ACO was eligible to share in savings. If the ACO met the quality performance standard, they would share in savings according to a final savings rate that was edited based on their own quality performance, up to a performance payment limit. This was calculated by multiplying the final sharing rate for the individual ACO (as determined by the ACO’s track/level) by the ACO’s quality score. With this approach, the ACO was in command of the shared savings they would receive. The ACO decided on the track/level, which determined the final sharing rate and the ACO decided on the effort they put forth toward reaching a top-quality score, to then determine what final sharing rate they achieved.

The major change that will impact an ACOs visibility of achieving shared savings is a result of the new APM Performance Pathway (APP). First, it’s important to note that starting with 2021, MIPS quality performance category scores for ACOs that have reported through the APP will be used for purposes of the Shared Savings Program in determining shared savings and shared losses, thus satisfying the reporting requirements for both programs (ACO MSSP and MIPS). For 2021, all ACOs (other than new ACOs in their first performance year of their first agreement) must reach a quality performance score that is equal to or above the 30^th percentile across all MIPS quality performance category scores. If an ACO reaches the 30^th percentile threshold, they will be eligible to share in savings at the maximum sharing rate according to the applicable financial model. This means that ACOs will have to wait until after the performance year, after the data submission season and after CMS has compiled all MIPS quality performance category scores in order to know if they achieved the threshold to share in savings.

The new APM Performance Pathway (APP) was finalized with the intention to align with the MIPS Value Pathways (MVPs) framework (implementation planned for 2022). The goal of both is to create a more streamlined Value-Based Care reporting mechanism that reduces provider burden by consolidating activities that meet requirements across all pathways. Yes, ACOs may now have a more limited view into how likely they are to achieve the quality performance standard and be able to share in savings starting with the 2021 APP. The positive spin, however, is that if the ACO does meet the quality performance standard, they will not only fulfill the reporting requirements across all pathways but they will also be eligible to share in savings at the maximum sharing rate according to their applicable financial model. Their final sharing rate will no longer be based on the 2 elements of: if they met the quality performance standard and then the calculation of the quality score multiplied times the sharing rate for the respective model. If the ACO is good enough to be at or above the 30^th percentile for all MIPS quality performance scores, then they will be eligible to enjoy the max sharing rate according to their respective financial model.