ACOs could help physicians earn up to 25% positive payment adjustment under MIPS

Participating in a Medicare Shared Savings Program ACO could potentially help physicians earn up to a 25 percent positive Medicare payment adjustment in 2018 under the Medicare Access and CHIP Reauthorization Act's Merit-based Incentive Payment System, according to an issue brief from Caravan Health, a population health management firm.

The issue brief projects and compares potential MIPS payment adjustments for physicians participating in MSSP ACOs versus those who are not participating in such programs. The analysis suggests MSSP ACO participants may be better poised to earn exceptional performance bonuses in the MIPS track, which when added to the maximum positive payment adjustment and scaling factor, means in a best-case scenario, a practice could earn up to a 25 percent positive payment adjustment on Medicare Part B payments in 2018.

"MACRA requires that 30 percent of the MIPS score is based on resource utilization. [MSSP] Track 1 ACO participants, however, are held accountable for cost in their ACO and not MIPS. As a result, Track 1 ACO participants can more easily achieve high scores compared to other MIPS participants, increasing the likelihood of avoiding MIPS penalties and earning the exceptional performance bonus," LeeAnn Hastings, compliance officer for 23 MSSP ACOs and one of the brief's authors, said in statement.

However, Caravan Health expects up to 40 percent of MIPS participants to be involved in Track 1 MSSP ACOs. This is important because MIPS, unlike its antecedent programs, is "curved" in the sense that performance scores are relative to the scores of the rest of the nation.

Due to the peer scoring system, Caravan Health CEO Lynn Barr recommends small physician practices and community hospitals begin evaluating their options for joining an ACO.

View the brief in full here.


More articles on accountable care:

Primaria Health adds to primary care network, launches ACO
ACOs saved $345 per patient in 2012, study finds
Applications open for CMS' Next Generation ACO Model

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