Archives     Advertise     Editorial Calendar      Advertiser Index     Subscribe     Contact Us    


Medical Groups Urge CMS to Walk Back ACO Quality Overhaul


 

In a letter to Department of Health and Human Services Secretary Xavier Becerra, eleven leading healthcare organizations are calling on the Biden administration to delay and make significant changes to the way accountable care organizations (ACOs) report and are measured on quality -- citing rushed implementation, still unanswered questions on changes, and potential negative consequences to patient care.

"The changes ignore the time it takes to adopt and implement electronic measures," the letter states. "Therefore, key policy changes and additional time are needed to ensure that ACOs can participate successfully, and that patient care is not negatively impacted."

At a time when the healthcare industry continues to deal with the uncertainty of the ongoing pandemic, in the final weeks of 2020 the Centers for Medicare & Medicaid Services (CMS) released the 2021 Medicare Physician Fee Schedule, which finalized a move to electronic quality measures for ACOs, among other changes. The move requires ACOs in the Medicare Shared Savings Program to aggregate data from disparate electronic health records (EHR) systems, which are not interoperable, and report on quality data on all patients regardless of payer, raising issues with collecting data from non-ACO providers and on patients with no connection to the ACO. The move could also widen health disparities as ACOs' quality performance could be misrepresented as differences in quality when variation is likely due to patient access to care or complexity. The changes take effect this year and next year, the most notable of which are mandated in 2022.

"ACOs treating vulnerable populations have a different mix of payers and patients, which will cause them to appear to have lower quality," the letter states. "This will reduce their shared savings at a time they should be receiving more resources to combat health equity issues and more support to remain on the path to value."

In a recent survey fielded by the National Associations of ACOs (NAACOS), where a quarter of all MSSP ACOs responded, nearly 75 percent stated their ACO is either "extremely concerned" or "very concerned" with the requirement to implement electronic Clinical Quality Measures (eCQMs) or Merit-based Incentive Payment System (MIPS) CQMs in 2022. Also from the survey, 85 percent said aggregating data from ACO participants' EHRs would be either "difficult" or "very difficult" to report.

The letter makes several recommendations, based on input from ACOs, including:

  • Delaying the mandatory reporting of eCQMs and MIPS CQMs for at least three years.
  • Limiting ACO reporting to ACO-assigned beneficiaries only, rather than all patients across payers.
  • Reassessing the appropriateness of the measures included in the Alternative Payment Model (APM) Performance Pathway (APP) measure set and soliciting additional input prior on a complete set of measures for MSSP reporting.
  • Clarifying and establishing quality performance benchmarks in advance for all ACO reporting options.
  • Retaining pay-for-reporting when measures are newly introduced or modified.

"To start 2021, 477 ACOs are participating in the MSSP, down from a high of 561 in 2018 and the lowest since 480 participated in 2017. The program is further threatened by these quality changes," the letter stated. "We request CMS correct the flawed MSSP quality overhaul as an early step towards strengthening the MSSP and the overall shift to value in Medicare."

The letter was signed by the American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, AMGA, America's Essential Hospitals, America's Physician Groups, Association of American Medical Colleges, Federation of American Hospitals, Medical Group Management Association, and the National Association of ACOs.

The letter writers are concerned if changes are not made soon, ACOs and their participants will bear significant health information technology (IT) costs and upgrades to be able to collect and report data, may drop clinicians, particularly specialists or small practices because of additional reporting burdens and IT costs, or ACOs could drop out of the program altogether.

 
Share:

Related Articles:


Recent Articles

Meharry Medical College and University of Memphis Launch PECIR Program, Driving Research Collaborations

Read More

UPDATE: UnitedHealthcare Policy on Emergency Coverage

Read More

ACEP Condemns UnitedHealthcare's New Policy to Retroactively Deny Emergency Care

The American College of Emergency Physicians (ACEP) strongly condemns the dangerous decision by UnitedHealthcare to retroactively deny emergency care claims.

Read More

Gerald E. Harmon, M.D., Inaugurated as 176th president of the AMA

Gerald E. Harmon, M.D., a family medicine physician from Pawleys Island, S.C., will be sworn in today as the 176th president of the American Medical Association (AMA), the nation's premier physician organization.

Read More

American Telemedicine Association: Policy Halftime Report As State Legislators Head Into Summer Recess

As most state legislators head into summer recess, the American Telemedicine Association (ATA) reflects on a very active first half of the year, which saw all 50 state legislatures introducing new or updated telehealth bills.

Read More

NIH-funded study tests "one-stop" mobile clinics to deliver HIV, substance use care

One of five mobile health clinics deployed for the NIH-funded INTEGRA study. Artwork for the clinic was designed by artist Shepard Fairey.

Read More

COVID-19 Pandemic Brought Changes in Cigarette Smoking: Study

Smokers who believed they were at increased risk of getting COVID-19 during the pandemic, or having a more severe case, were more likely to quit while those who perceived more stress increased smoking, according to new research published in the Journal of General Internal Medicine.

Read More

Secret Shopper Study Sheds Light on Barriers to Opioid Treatment for Women

After a 2020 Vanderbilt University Medical Center study showed women have a difficult time accessing treatment for opioid use disorder (OUD), investigators analyzed comments received from the study's participants to further shed light on barriers to care, which included everything from long on-hold times to difficult interactions with clinic receptionists during phone calls seeking appointments.

Read More

Predictive Model Identifies Patients for Genetic Testing

Patients who, perhaps unbeknownst to their health care providers, are in need of genetic testing for rare undiagnosed diseases can be identified en masse based on routine information in electronic health records (EHRs), a research team reported today in the journal Nature Medicine.

Read More

AMA Announces New Effort Aimed at Standardizing Blood Pressure Measurement Training at Medical and Health Profession Schools Across the U.S.

New e-learning modules provide consistent, evidence-based BP measurement techniques for students at health care schools nationwide--addressing gaps in current training to improve national blood pressure control rates

Read More

Email Print
 
 

 

 


Tags:
None
Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: