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With the continual market shift from fee-for-service to fee-for-value, Accountable Care Organizations (ACO) face the challenge of aggregating data from multiple organizations to meet Quality Measures (QMs) regulations and improve the health of their patient populations.
As part of CMS’s push for simplicity, the ACO REACH program has only four quality measures, compared to past MSSP ACOs’ 33 QMs or MIPS’ menu of 200. Not only that, but three of the four are reportable through EMR integration, therefore chart chasing is no longer required. ReportingMD provides population health analytic solutions while supporting networks, groups and hospitals in the ACO Reach Model.
Here’s a quick run-down of the four measures:
ACR looks at the fraction of hospital stays that result in a readmission within 30 days of discharge. Claims-based.
UAMCC is slightly more complicated, looking at the rate per 100 person years of hospital readmissions for aged Medicare patients with two or more chronic conditions. Claims-based.
Timely Follow-Up looks at whether doctors delivered follow-up care within the timeframe laid out by clinical guidelines for patients with an ED visit or hospitalization related to six specific chronic conditions. Claims-based.
CAHPS® is a standard survey to measure the quality of patients’ experiences, administered by a CMS-approved vendor in collaboration with the ACO.
Facilitating engagement with patients at admission is crucial for managing potential readmission and ensuring a timely follow-up. ReportingMD, Inc. has the expertise to get your ACO prepared so you can maximize your quality performance scoring to maintain the highest possible percent of shared savings your ACO worked so hard to achieve. Although the actual mechanics are more complex, these four measures – and the aligned economics of the REACH model – are the only quality variables doctors need to consider, freeing up their time to focus on what matters: patient care and outcomes and cost containment.
Starting with the 2021 reporting year, Accountable Care Organizations (ACOs) can report quality data through the new APM Performance Pathway (APP). They can report the 10 measures via the CMS Web Interface OR 3 MIPS eCQMs/CQMs. Mandatory reporting through the APP will begin in 2025.
Additionally, ACOs must conduct the CAHPS for MIPS Survey, and CMS will use administrative claims data to calculate 2 measures. Depending on the chosen reporting method, either 6 or 10 measures will contribute to the ACO’s MIPS quality performance category score.
If an ACO reports both the 10 CMS Web Interface measures and the 3 eCQMs/CQMs, it will receive the higher of the two quality scores for the MIPS quality performance category. The 3 eCQMs/CQMs are:
ACOs can choose a submission method for these 3 quality measures that best fits their needs (e.g., direct, login and upload, or a third-party intermediary). For example, they might use a CMS Qualified Registry like ReportingMD to submit quality data on their behalf.
Each measure that meets data completeness (submitted data for at least 70% of the denominator eligible patients/instances) and case minimum (at least 20 cases) requirements will be scored between 1 and 10 points based on performance against established benchmarks.
The CMS Web Interface will be phased out after the 2024 performance year. Starting in 2025, ACOs must report the 3 eCQMs/MIPS CQMs through the APP. Additionally, ACOs will still need to conduct the CAHPS for MIPS Survey, and CMS will continue to calculate 2 measures using administrative claims data. All 6 measures will be included in the calculation of the ACO’s MIPS quality performance category score.
Further guidance can be found in the CMS document: “Reporting MIPS CQMs and eCQMs in the Alternative Payment Model Performance Pathway (APP).“
CMS will incrementally raise the quality performance standards for ACOs in the Shared Savings Program and incentivize the reporting of the 3 eCQMs/CQMs for the 2022 and 2023 performance years.
2022 to 2023: ACOs will meet the quality performance standard for determining shared savings and losses if they:
2024: ACOs will meet the quality performance standard for shared savings and losses if they:
2025 and Beyond: ACOs will meet the quality performance standard for determining shared savings and losses if they achieve a quality performance score at or above the 40th percentile of all MIPS quality performance category scores.
At ReportingMD, our cloud-based, ONC Certified, HIPAA-compliant, Total Outcomes Management (TOM™) population health analytic platform is specially built with best-in-class technology to support the needs of healthcare organizations.
With an easy to use interface and near universal compatibility with all EMRs, TOM™ marries clinical encounter data with adjudicated claims data to provide real-time operational visibility into patient and population health.
ReportingMD solutions provide a real-time 360-degree view of your population.
