In deciding whether to join an ACO, physicians should understand that the range of quality measures they can select for MIPS is limited. Eligible clinicians reporting on their own can pick any six quality measures from a list of 271 metrics.
In contrast, ACOs that participate in MSSP are reporting on 31 quality measures in 2017, and those are also reported to MIPS. While the number of ACO metrics is greater than for individual practice reporting, there is no choice of measures.
Many ACOs also have commercial payer contracts that require data reporting on a large number of quality measures, Mastagni says. Some ACOs, she notes, are tracking as many as 100 different metrics. This is also a problem for practices that have multiple value-based care contracts.
ACOs can help practices handle these requirements, as well as population health management, but they need an information technology infrastructure that is equal to the challenge. “Sophisticated data systems are something that organizations should look for in an ACO,” Teske points out.
To assess an ACO’s technology, Mastagni says, practices should ask how often the ACO updates quality measures and how it disseminates that information to providers.
In addition, practices should find out whether the ACO uses a quality dashboard that simply conveys members’ quality scores or whether the dashboard also includes a registry that generates lists of patients they should contact to close care gaps and improve quality rankings. “Assistance with interpretation of the data and outreach to patients are common services of an ACO,” she says.
Practices should also investigate their requirements for supplying data to the ACO, and what they’ll get back in return, she notes. In addition, she suggests asking about the ACO IT staff’s ability to optimize the use of its technology.
While there is an option for practices to send quality data directly from their EHRs to CMS, Fields says navigating MIPS “is complex and hard to understand if you do it on your own.” But independent practices can also choose between using a CMS-approved registry, a CMS-approved EHR vendor or an ACO to report their quality data electronically.
Alternatively, practices can use a manual claims-based method, which requires physicians to enter special codes for each patient visit for which they provide services subject to quality measures. Zetter says that practices without EHRs and those that don’t trust their EHRs may report quality data through claims.
CMS-approved commercial registries and qualified clinical data registries, which are mostly run by specialty societies and quality collaboratives, charge only a few hundred dollars per provider per year, Zetter says. But practices have to find a registry that will work with their EHRs, he notes. Mastagni says that registries’ fees don’t include the cost of EHR interfaces. Vendors don’t need those interfaces, and, according to Zetter, charge about the same amount as registries.
Mission Health Partners doesn’t charge for quality reporting beyond its initial participation fee of $500 per provider, Fields says. However, while independent doctors control the ACO’s board, a large healthcare system owns the ACO, which may account for the low cost.
According to Mastagni, healthcare systems that form ACOs generally don’t charge independent practices to join them. They are looking for referrals rather than a direct financial return, she says.
Brull’s ACO, which is managed by Aledade, has a different kind of business model. It provides quality reporting for free, but takes a percentage of the shared savings achieved under its contracts.
“Reporting did take work, but the process was well organized and easy to understand,” Brull says. “At the end of it, I felt that I was submitting the most accurate quality data I have ever been able to turn in.”