As Accountable Care Organizations (ACOs) prepare for the 2025 performance year, our ACO Quality Performance Score Calculator can help you estimate whether you’ll meet the 76.7% Quality Performance Standard needed to earn the maximum shared savings under Medicare CQMs:
One of the biggest surprises for many ACOs is that reaching the 40th percentile in every quality measure does not equal a 40% ACO Quality Performance Score — and in fact, it can still mean losing half of your shared savings.
The 40% Misconception
The Quality Performance Score is not a simple average of your measure percentiles.
Instead:
Your measure performance (%) is converted into a MIPS score based on national benchmarks.
The six MIPS scores are averaged, then scaled into the ACO Quality Performance Score.
Because of the way MIPS scoring works, 40th percentile performance in each measure often translates to MIPS scores in the 5-point range — and the final ACO Quality Performance Score can fall well below the 76.7% target.
Example: The 40% Scenario
The example below uses 2025 benchmarks and assumes an ACO achieves the 40th percentile in 6 measures:
Result:
ACO Quality Performance Score = 50%
Status: Met Alternative Quality Performance Standard — earns only 50% of the track’s maximum sharing rate.
Why MIPS CQMs/eCQMs Are More Forgiving
For ACOs reporting Medicare CQMS, all six measures must meet higher percentile thresholds to reach the 76.7% standard.
In contrast, MIPS CQMs or eCQMs only require:
One outcome measure at the 10th percentile or higher
One additional measure at the 40th percentile or higher
This flexibility makes CQMs/eCQMs statistically easier for some ACOs to pass — especially when adapting to the broader Medicare population.
Data Source & 2025 Challenges
Our calculator uses 2023 CMS Web Interface performance data from data.cms.gov as a baseline.
However, in 2025:
Medicare CQMs will require reporting for almost all Medicare patients who had an office visit with any of the ACO participants.
Populations will be larger and more diverse than 2023’s CMS web interface sample.
Performance rates may drop due to data completeness and operational changes.
For many ACOs, matching 2023 results will be difficult under full Medicare CQM reporting.
Next Steps for ACOs
Use preliminary data from your EHR or test CQM runs in the calculator.
Identify measures that need improvement now — don’t wait until submission.
Understand that hitting 40% in each measure is not enough if your goal is maximum shared savings.
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