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.

2017 ACO Quality Measure Reporting

  • 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.
  • 15 GPRO Web-Interface Measures:
    • CARE-1 Medication Reconciliation Post- Discharge
    • CARE-2 Falls: Screening for Further Fall Risk
    • PREV-7 Preventive Care and Screening: Influenza Immunization
    • PREV-8 Pneumonia Vaccination Status for Older Adults
    • PREV-9 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
    • PREV-10 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
    • PREV-12 Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan
    • PREV-6 Colorectal Cancer Screening
    • PREV-5 Breast Cancer Screening
    • DM-2 Composite (All or Nothing Scoring): Diabetes: Hemoglobin A1c Poor Control
    • HTN-2 Controlling High Blood Pressure
    • IVD-2 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
    • MH-1 Depression Remission at Twelve Months
    • DM-7 Composite (All or Nothing Scoring): Diabetes: Eye Exam
    • PREV-13 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

Many ACOs are considered Alternative Payment Models (APMs), which promote a new direction for handling the payment of medical care through Medicare that incentivizes quality and value. The APM payment approach adds financial incentives to clinicians to provide high-quality and cost-efficient care. Some APMs have different scoring under the MIPS program and are thus known as MIPS APMs.

Advanced Alternative Payment Models (Advanced APMs), are a subset within the larger APM approach. Advanced APM participation requires clinicians and practices take on a nominal amount of financial risk in addition to other requirements. If Advanced APM participation meets certain programmatic and Part B professional service billing threshold requirements, those participants are deemed either Qualifying APM participants (QPs) or partial QPs. QPs are not subject to MIPS reporting and partial QPs have the choice of reporting under MIPS or not. Advanced APMs can enjoy specific rewards along with a 5% lump sum incentive.

For more information visit:  CMS.gov, Quality Measures and Standards