Membership in an accountable care organization (ACO) can reduce the burden of quality reporting to Medicare’s value-based payment programs and to commercial health plans. But physicians should not join an ACO for that reason alone, because they may be unprepared for the kinds of practice changes that an ACO requires, experts say.
Many ACOs do most or all of the data collection, while also giving physicians feedback on their performance. This can be especially helpful for small, independent practices that don’t have any other way to measure how well they’re doing in relation to their peers.
However, practices should ask some hard questions about these capabilities before joining an ACO, healthcare consultants say. They should find out, among other things, how much of the data collection they will have to do, how timely and useful the feedback will be, and whether there is a separate charge for the service.
“The value-based payment systems require quality reporting, and in order to participate and get the funding they want, the practices are sort of driven to ACOs to provide a little bit of support,” says Erin Mastagni, MPH, a senior manager at ECG Management Consultants. “But that’s only if they want that sort of payment and can agree to the other care model changes. So it’s more about the shift to value-based care.”
Many factors to consider
Mastagni and David Zetter, PHR. a practice management consultant in Mechanicsburg, Pennsylvania, emphasize that practices must weigh the pros and cons of ACO participation beyond just quality reporting. For example, an ACO can help a practice with contracting, prepare it for value-based care and support it with population health management software.
On the other hand, physicians in ACOs must follow certain practice guidelines and they may have to hire care managers. In Zetter’s view, no practice should join an ACO just for quality reporting.
But why would it be easier for a practice to have the ACO do their quality reporting than to do it on their own or through their EHR vendor? Also, how could it help them improve their quality scores?
For one, physicians can benefit from having the ACO report data because “we simplify the process of reporting,” argues Rob Fields, MD, medical director of Mission Health Partners, an ACO in Asheville, North Carolina. “You send us the canned report and we do the formatting and validation and take on the audit risk of making sure that it gets to the federal government in the way it should.” Also, he says, the ACO members’ practice managers regularly network and exchange ideas to improve their quality scores.
The ACO gets a lot of questions from members about the Merit-based Incentive Payment System (MIPS) of the Centers for Medicare & Medicaid Services (CMS), he notes, because the program is difficult to figure out.
“That’s one of the biggest value propositions we offer: We can provide the education and simplify the process,” says Fields. “You don’t necessarily need to understand all of it. You just have to understand enough to give us the quality reports, and we can take care of the rest.”
Josh Israel, MD, lead of clinical quality initiatives for Aledade, a company that manages two dozen primary care ACOs across the U.S., says that the firm offers informational materials, live training sessions and weekly “ask anything” phone seminars to help practices improve their quality measures.
“Effective and seamless quality reporting is a challenge, but a combination of technology and direct support can ease the transition to a healthcare system focused on value with the lowest burden to physicians,” he says.