MSSP ACO? 3 Quality Updates You Need to Know from the CY2022 Medicare Physician Fee Schedule Final Rule

MSSP ACO? 3 Quality Updates You Need to Know from the CY2022 Medicare Physician Fee Schedule Final Rule

Healthcare Data Quality Reporting

The recent release of CMS’ CY2022 Medicare Physician Fee Schedule Final Rule is an important document for nearly every type of health care organization. And if you are a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO), this document provides the critical information you need to best position your organization for success. While the rule details out numerous policy updates, here are the 3 most important updates you need to know around the quality category.

#1 Performance Thresholds to Incentivize Transition

CMS sets a quality performance standard that participants must hit if they want to share in the savings. Historically, if MSSP ACOs hit the 30th percentile across quality scores, they could receive the upside benefit. There was talk of increasing the standard to the 40th percentile, but this program change has now been pushed back to 2024.

Key takeaway for PY2022: A MSSP ACO will meet the performance standard if their quality score is equivalent or higher than the 30th percentile – OR – reports 3 eCQMs/MIPS CQMs and hits the 10th percentile or higher of the benchmark on at least 1 of the 4 outcome measures.

#2 Sunsetting of the CMS Web Interface

In a prior blog, we discussed how with the transition to reporting eCQMs/MIPS CQMs, ACOs were to report performance via a third-party intermediary, like a CMS Qualified Registry. The final rule delays sunsetting the Web Interface until PY2024 to give organizations more time to find technology that supports digital quality measurement and reporting.

Key takeaway for PY2022: CMS recognizes the obstacles associated with evolution to digital quality systems and will continue to provide the CMS Web Interface to give MSSP ACOs more time to procure and implement technology solutions needed to report via the APP.

#3 Calculating Performance by Reporting Type  

Each MSSP ACO’s quality score will be calculated based upon the method in which the organization reported their quality performance. If the ACO choses to submit the traditional method via the Web Interface, the score will be based on aggregated performance across 10 measures (7 CMS Web Interface measures, 1 CAHPS survey measure, 2 claims-based measures). If the ACO choses to report the 3 eCQMs/MIPS CQMs, performance will be calculated across 6 measures (3 eCQM/MIPS CQMs, 1 CAHPS, 2 claims). If both reporting methods are used, the ACO will receive the higher of the two quality scores.

Key takeaway for PY2022: Report 10, get scored on 10. Report 3, get scored on 3. Report both and get the benefit of CMS using whatever quality score is higher.

Health care is facing critical tests with our financial sustainability under threat and the transition to a value-driven payment system. For health care organizations and providers, the writing is on the wall – performance-based payments, digital quality measure systems, direct API reporting. It pays to stay up on these changes from leading organizations like CMS, NCQA and ONC so you’re able to make smart choices to successfully serve your community. Read the full Final Rule here: https://www.federalregister.gov/public-inspection/current


Renee Towne

About the Author
Renee Towne
VP of Population Health at KPI Ninja, Inc.
Renee provides operational leadership of quality initiatives at KPI Ninja. Towne has a background in occupational therapy, education and experience in operational excellence across a variety of healthcare domains. Based on prior experience as a clinician that drove outcomes patient by patient, she is leaving a larger footprint by improving health care more comprehensively, population by population.


About KPI Ninja
KPI Ninja is a data analytics company that helps healthcare organizations accelerate their quality, safety, and financial goals with a unique combination of software and service. We are differentiated by our signature mix of technology, performance management consulting and healthcare expertise. We don’t merely offer software solutions but work shoulder to shoulder with clients to help them draw on the power of analytics and continuous improvement methodologies to become more efficient. In harmony with our data-centered ethos, we truly believe that our success is strongly co-related with yours.

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