Of the 923 ACOs active in commercial payer and federal programs, 563 hold Medicare contracts, according to a recent study published in Health Affairs. Most of these ACOs participate in the Medicare Shared Savings Program (MSSP), which requires them to report on a specific group of quality measures. When that data is reported to MSSP, it is also reported to MIPS, so ACO participants do not have to send their quality data separately. They also get credit for clinical improvement activities—another MIPS requirement—if their ACO is in the MSSP.
However, ACOs average the data of all their participating practices when they report to Medicare. For a practice with low quality scores, this can be an advantage. But if a practice has higher quality scores, ACO reporting can drag down its scores, not only in MIPS, but with commercial insurers. In other words, the quality scores that affect value-based payments to a practice depend largely on how well the other ACO participants do.
Practices that are considering joining an ACO should ask to see the ACO’s quality data to get an idea of its historical performance, says Krista Teske, a physician practice roundtable consultant for the Advisory Board Co., a Washington, D.C.-based consulting firm. In addition, ACO quality scores are available on the CMS website. But those posted scores are a year or two out of date.
Wendy Coin, MD, a primary care physician in a 21-provider practice in Asheville, North Carolina, says that her group is not happy with the average quality data for the Mission Health Partners ACO, in which it participates.
“We knew that we had higher quality scores and a higher level of sophistication [than other local groups] when we entered the ACO,” she says. “So we had concerns about that, but we’re taking a deep breath and having faith. Joining an ACO seemed like the right thing to do to prepare for the coming changes in the reimbursement systems.”
Jennifer Brull, MD, part of an eight-provider primary care practice in Plainville, Kansas, says she has no concerns about quality score averaging, although her group is one of the top performers in its ACO. “I am hoping to increase our revenues with shared savings, and we cannot do that as an individual practice, so reporting quality as a group makes sense,” she says.
ACOs usually collect clinical data from the EHRs of member practices for quality reporting, Teske says. If there are many different EHRs within the organization, it may be cost-prohibitive to write interfaces to all of those systems. On the other hand, if an ACO consists mostly of practices within a single organization, or requires its members to use a single EHR, it’s easy to extract the data electronically, notes Zetter.
This often happens in ACOs formed by healthcare systems that employ doctors, but some hospital-owned ACOs include community practices with multiple EHRs.
ACOs owned and operated by independent physicians are also likely to have different EHRs, says Mastagni. In that case, the ACO may have to send people into the practice to pull the quality data, which can be an expensive and time-consuming task, she says.