Are you waking up to an ACO hangover?

Man with hands covering eyes

June 28, 2017

You're not alone!

CMS reports 480 active Accountable Care Organizations with over 18k entities participating (2017). Many physicians, primary care and specialists alike, are waking up to find their Accountable Care Organization participation less beneficial than expected. Only 31% of Medicare Shared Savings Programs have managed to reduce cost and increase quality at levels acceptable for shared savings. That leaves a whopping 69% jumping through administrative hoops without much identifiable benefit to physician or patient.

It is likely that you joined an ACO to benefit from quality measure reporting, transition support, and a portion of the elusive shared savings. The good news is that there are other options.

You can regain control

  • Develop a strategy that aligns with your goals and specialty
  • Focus on quality measures that align with your patient demographics
  • Invest time and resources that provide a ROI, based on your interest

To regain control and capture incentive payments, clinicians must determine if ACO participation is in the best interest of their patients and practice. Specialists will find that the core quality measure set defined by CMS doesn't allow for their direct contribution to quality measures or represent the care they provide. Clinicians join and disconnect from ACOs for a variety of reasons - participation is strictly voluntary.

Time to Disconnect

CMS imposes criteria for disconnecting from an ACO. The process is simple enough; however, you need to be aware that there are reporting and time constraints. For starters, the ACO 2017 participant list has already been established. CMS will assign the ACO quality score to ALL participating NPI and TIN associated with the ACO for 2017.

In the event, that the ACO fails to report – providers have an opportunity to self report for compliance and a bonus under MIPS. Monitor the ACO for this limited opportunity. Failure of the ACO to report and missing your Plan B opportunity results in a penalty.

Here is the opportunity and urgency

The ACO participation list for 2018 will be established soon. In the event, that you wish to report MACRA/MIPS independently for 2018, you will need to provide notice to the ACO. The 2018 Change Request Cycle (4) ends on Oct 26, 2017. This is the final date for CMS to be notified, by the ACO, of non-participation for 2018. Check ACO requirements for disconnecting, some need a 60-day notice to remove members from their participant list.

Many ACO members are identifying gaps in the service offered by their ACO. Most ACOs can't offer analytic platforms and technology solutions that drive efficiency and improvement outcomes. Explore the use of an analytic engine to align your strategy, improve quality and identify patient gaps.

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