Medicare Shared Savings Program Seeks High ACO Performance

November 06, 2015 - As part of the Patient Protection and Affordable Care Act, goals of improving the quality of healthcare services and reducing costs led to the creation of Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program. Both quality data reporting and the collection of ACO quality metrics are vital in order for the Medicare Shared Savings Program to generate results, according to the Centers for Medicare & Medicaid Services (CMS).

ACOs that meet the performance standards set forth in the quality metrics requirements will be able to share in the savings garnered from the federal program. Additionally, ACO providers need to take part in other measures alongside ACO quality reporting such as the EHR Incentive Programs, the Physician Quality Reporting System (PQRS), and Physician Value-Based Payment Modifier.

There are 33 quality measures that ACO quality reporting consists of, which span four different areas of care including care coordination and patient safety, the patient experience, preventive care strategies, and managing at-risk population health.

“Before an ACO can share in any savings created, it must demonstrate that it met the quality performance standard for that year. CMS will measure quality of care using 33 nationally recognized quality measures in four key domains,” a CMS guidance stated.

The 33 ACO quality reporting measures include getting timely care and appointments, access to specialists, physician communication metrics, vaccinations and immunizations, mammography screening, colorectal cancer diagnostics, shared decision making, and patient education.

CMS also defined the process of reporting ACO performance standards in a brief called Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year. During the first performance year, an ACO needs to accurately report complete results of their quality measures.

During the years following, CMS will begin assessing the Accountable Care Organization based on the performance benchmarks part of the Medicare Shared Savings Program. When creating the ACO quality measure benchmarks for 2015, CMS used 2012 Medicare fee-for-service data.

Once an ACO has reported its quality metrics data, CMS is then able to use quality scoring to determine whether the organization will participate in some of the cost savings from the program.

A sliding scale is used to determine the performance level of an ACO. Each domain receives an individual score and the final overall quality score will be used to determine the amount of savings it earns or the losses it owes.

According to the CMS website, Accountable Care Organizations participating in either the Medicare Shared Savings Program or the Pioneer ACO Model can register to report Physician Quality Reporting measures through the Group Practice Reporting Option (GPRO) Web Interface. To learn more about the GPRO Web Interface option and its requirements, click here.

“ACOs are groups of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that agree to work together to coordinate care for the Medicare Fee-For-Service (FFS) patients they serve,” according to the CMS guidance.

“The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries, instead of the fragmented care that often results from a Fee for Service payment system in which different providers receive different, disconnected payments. ACOs will be responsible for maintaining a patient-centered focus and developing processes to promote evidence-based medicine, promote patient engagement, internally and publicly report on quality and cost, and coordinate care.”

If an Accountable Care Organization is able to achieve high performance scores and reduce the overall costs of healthcare delivery across the group practices, there is a higher likelihood of gaining shared savings through the federal program.