MACRA Performance Scores can be enhanced by 30% through ACO Participation

Eligible clinicians must strategize the implications of payment under the program with the 1st performance year for the new Merit-Based Incentive Payment System (MIPS) underway. In contrast to the Physicians Quality Reporting System, Meaningful Use (MU) and the Value-Based Modifier, the performance of each clinician has been placed by MIPS on a curve, and adjusts payments deployed on their precise location in the distribution in comparison to others.

An issue brief, Impact of ACOs on MIPS Payments for All Eligible Clinicians has been released by Lynn Barr, MPH, CEO of Caravan Health, and LeeAnn Hastings, JD, MPH, Compliance Officer for 23 Medicare Shared Savings Program ACOs, making comparison of MIPS payment adjustments of ACO participants versus non-ACO participants. In accordance to the brief, Medicare Shared Savings Program (MSSP) participation will increase the MIPS performance and increase the likelihood of getting the exceptional performance bonuses. Exceptional performance bonuses are merely available the first 5 years of MIPS and, relying upon the number of exceptional performers, could get up to 10% in addition to the maximum positive payment adjustment, which is up to 3 times the penalty for the first 5 years of the program. Taking into account the scaling factor of CMS (Centers for Medicare & Medicaid Services) and the exceptional performance bonus, a top-performing practice could theoretically gain up to a 25 percent payment adjustment in the 2018 performance year.
"MACRA needs that 30 percent of the MIPS score is deployed on Resource Utilization. Track 1 ACO participants, although, are held accountable for cost in their ACO and not MIPS. As an outcome, Track 1 ACO participants can more conveniently achieve high scores in contrast to other MIPS participants, enhancing the likelihood of ignoring MIPS penalties and earning the exceptional performance bonus”, in accordance to Ms. Hastings.
Barr asserts that clinicians must know both their performance score and estimate the score of the remaining providers in the MIPS pool in case to predict MIPS bonuses. Up to 40 percent of eligible clinicians in the pool are hoped to be participants in Track 1 Medicare Shared Savings Program ACOs. Those accountable care organizations (ACOs) will get special scoring causing most other MIPS-eligible clinicians to receive lower adjustments in comparison.
"Small practices should consider merging an ACO to ignore penalties for generally lower scores because of the deficiency of infrastructure, and providers in rural might need to join ACOs to avoid MIPS penalties due to their higher cost structures. Community hospitals can earn high bonuses and support their community physicians, specifically specialists, by enrolling them in their ACO, securing their incomes and decreasing their administrative burden”, Barr states.
Caravan Health, who presently supports 160 community hospitals and 250 practices in 23 Medicare Shared Savings Program ACOs, is holding weekly webinars to assist providers to navigate the ACO procedure and completely understand how to enhance their incentive payments. Participants will get step-by-step financial guidance on how to calculate potential penalties and bonuses under the MACRA.
On Fridays, Webinars are held at 8:30am PT/10:30am CT/11:30am ET. To register, visit www.caravanhealth.com/upcomingevents/.
To download the full brief, Impact of ACOs on MIPS Payments for All Eligible Clinicians, please visit www.caravanhealth.com/macra.