Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program will have new reporting requirements beginning in 2025. The Centers for Medicare and Medicaid Services (CMS) has established a multi-year transition period to change the data that these organizations must report and how the data gets submitted. The changes are intended to reduce reporting burdens and improve patient outcomes. Partnering with a CMS Qualified Registry like MDinteractive can ease the transition for ACOs and help them meet their data reporting needs.
Elimination of the CMS Web Interface in 2025
CMS will end the CMS Web Interface reporting option for Medicare Shared Savings Program (MSSP) ACOs in 2025. ACOs have a transition period for the 2021-2024 performance years before having to report all three eCQM/CQM MIPS measures established under the new Alternative Payment Model (APM) Performance Pathway.
- 2021-2024 - ACOs will be required to report either the 10 CMS Web Interface measures or the three all-payer eCQMs/MIPS CQMs. Under the APP, all ACOs will administer the CAHPS for MIPS Survey and be scored on two administrative claims-based measures (calculated by CMS).
- 2025 - ACOs will have to report on all three eCQMs/MIPS CQMs and administer the CAHPS for MIPS Survey. CMS will calculate 2 measures using administrative claims data. The CMS Web Interface will sunset.
APP Quality Measure Set
CMS is adopting a smaller measure set as part of the APP as highlighted in the table below.
*2021 - 2024 Only: ACOs could choose to continue reporting Quality measures via the CMS Web Interface.
| Measure # | Measure Title | Collection Type | Submitter Type |
|---|---|---|---|
| Quality ID#: 321 | CAHPS for MIPS | CAHPS for MIPS Survey | Third-Party Intermediary |
| Quality ID#: 479 | Hospital-Wide, 30-day, All-Cause Unplanned Readmission (HWR) Rate for MIPS Eligible Clinician Groups | Administrative Claims | N/A |
| Quality ID#: TBD | Risk Standardized, All-Cause Unplanned Admissions for Multiple Chronic Conditions for MIPS | Administrative Claims | N/A |
| Quality ID#: 001 | Diabetes: Hemoglobin A1c (HbA1c) Poor Control | eCQM/MIPS CQM/CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 134 | Preventive Care and Screening: Screening for Depression and Follow-up Plan | eCQM/MIPS CQM/CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 236 | Controlling High Blood Pressure | eCQM/MIPS CQM/CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 318 | Falls: Screening for Future Fall Risk | CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 110 | Preventive Care and Screening: Influenza Immunization | CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 226 | Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 113 | Colorectal Cancer Screening | CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 112 | Breast Cancer Screening | CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 438 | Statin Therapy for the Prevention and Treatment of Cardiovascular Disease | CMS Web Interface* | APM Entity/Third Party Intermediary |
| Quality ID#: 370 | Depression Remission at Twelve Months | CMS Web Interface* | APM Entity/Third Party Intermediary |
Quality Performance Standard
ACOs also have to meet a new quality performance standard to qualify to share in savings or avoid owing maximum shared losses. CMS plans to gradually phase in the increase in the level of quality performance as follows:
- 2022 - ACOs will meet the quality performance standard used to determine shared savings and losses if the ACO:
- Achieves a score ≥ the 30th percentile across all MIPS quality performance category scores*; or
- Reports the 3 eCQMs/MIPS CQMs (meeting data completeness and case minimum requirements) and achieves a score ≥ the 10th percentile of the performance benchmark on at least 1 outcome measure and a score ≥ the 30th percentile of the performance benchmark on at least 1 of the remaining 5 measures
- 2023 - ACOs will meet the quality performance standard used to determine shared savings and losses if the ACO:
- Achieves a score ≥ the 30th percentile across all MIPS quality performance category scores*; or
- Reports the 3 eCQMs/MIPS CQMs (meeting data completeness and case minimum requirements) and achieves a score ≥ the 10th percentile of the performance benchmark on at least 1 outcome measure and a score ≥ the 30th percentile of the performance benchmark on at least 1 of the remaining 5 measures; or
- An ACO that does not meet either of the above but meets the alternative quality performance standard by achieving a quality performance score ≥ the 10th percentile of the performance benchmark on at least 1 of the outcome measures would share in savings at a lower scaled rate.
- 2024 - ACOs will meet the quality performance standard used to determine shared savings and losses if the ACO:
- Achieves a score ≥ the 40th percentile across all MIPS quality performance category scores*; or
- Reports the 3 eCQMs/MIPS CQMs (meeting data completeness and case minimum requirements) and achieves a score ≥ the 10th percentile of the performance benchmark on at least 1 outcome measure and a score ≥ the 40th percentile of the performance benchmark on at least 1 of the remaining 5 measures; or
- An ACO that does not meet either of the above but meets the alternative quality performance standard by achieving a quality performance score ≥ the 10th percentile of the performance benchmark on at least 1 of the outcome measures would share in savings at a lower scaled rate.
- 2025 and future years: ACOs will meet the quality performance standard used to determine shared savings and losses if the ACO:
- Achieves a score ≥ the 40th percentile across all MIPS quality performance category scores*; or
- An ACO that does not meet the above but meets the alternative quality performance standard by achieving a quality performance score ≥ the 10th percentile of the performance benchmark on at least 1 of the outcome measures would share in savings at a lower scaled rate.
*Excludes entities/providers eligible for facility-based scoring.
If an ACO does not report either the CMS Web Interface measure set or the three eCQMs/MIPS CQMs in 2023 or 2024, or the three eCQMs/MIPS CQMs in 2025, and administer a CAHPS survey each year, they will not meet the quality performance standard or the alternative performance standard.
Benefits of Using a Qualified Registry
Collaborating with a Qualified Registry will make sense for many ACOs. Qualified Registries like MDinteractive can help ACOs comply with the data reporting requirements while supporting their ability to make informed decisions on how best to improve the quality of care for Medicare patients within their organizations.
Combining Data from Multiple Sources.
ACOs may face data collection and reporting challenges if they have multiple Tax Identification Numbers (TINs), or are currently using multiple EHR platforms or billing systems. We have extensive experience aggregating quality data before it gets submitted to CMS. MDinteractive can aggregate data for each of the three quality measures from multiple sources and in various formats, including different EHR files (QRDA, CSV, Excel, or PDF), billing files (MDinteractive standard billing templates, 837 claims files, and unique billing files), excel templates and custom files.
Know Your Performance.
It is important that ACOs monitor their performance throughout the year so they can make any necessary quality improvements to maximize their scores and incentive payments. MDinteractive’s software provides tools that allow ACOs to evaluate and monitor their performance at the ACO, TIN, and individual clinician National Provider Identifier (NPI) level.
Reliable Data Reporting.
MDinteractive has over 20 years of quality reporting experience with healthcare clinicians of all sizes and in all practice settings in every state. We have been a CMS Qualified Registry since 2010. Our customers include large academic medical centers, hospitals, billing companies, multi-specialty clinician groups, small groups, and solo practitioners.
Knowledgeable and Experienced Team.
At MDinteractive, our seasoned team helps ACOs navigate through the reporting process from beginning to end and offers advice on how to maximize their reimbursement and avoid sharing losses.
More information on how MDinteractive can prepare your ACO for reporting the APP Quality measures can be found here.
Key Takeaways
ACOs should begin evaluating their quality reporting strategy in light of the new changes to the quality metrics they will have to report and the elimination of the CMS Web Interface in 2025. Partnering with an experienced Qualified Registry like MDinteractive can help make it a smooth transition. We can help ACOs successfully comply with their quality reporting requirements and provide tools and support to help them increase their Medicare payments through higher earned shared savings.
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MACRA MIPS ACO Reporting APM Performance Pathway CMS Web Interface
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