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Report: ACO Enrollment Boosts MACRA Reimbursement

April 03, 2017

A recent report from Caravan Health found that by joining an accountable care organization (ACO), clinicians could raise key Medicare performance scores by up to 30%, increasing their opportunity of receiving higher reimbursements compared to competitors. 

The report, by Lynn Barr, MPH, CEO of Caravan Health, and LeeAnn Hastings, JD, MPH, a compliance officer for 23 ACOs under the Medicare Shared Savings Program (MSSP), compared payments for clinicians participating in an ACO under the Medicare Access and CHIP Reauthorization Act (MACRA) to those that were not.

The report analyzed clinicians covered under MACRA, receiving a reimbursement through the Merit-Based Incentive Payment System (MIPS). However, the study did not cover practices that are using value-based payments to pursue reimbursement under the advanced alternative payment model (APM) track.

Under MACRA, clinicians are often pushed away from a fee-for-service track and rates physicians against one another. Clinicians and practices that seek higher payments are at a disadvantage if they are not part of an ACO because ACO-enrolled clinicians are rated together for one key measure.

According to the report, participants in Track 1, who do not meet the criteria for advanced APMS, will be rated as a group with the rest of their ACO. The findings suggest that this measure makes up approximately 30% of the performance score.

“Small practices should consider joining an ACO to avoid penalties for generally lower scores due to lack of infrastructure, and providers in rural areas may want to join ACOs to avoid MIPS penalties due to their higher cost structures,” Ms Barr said in a statement. “Community hospitals can earn high bonuses and support their community physicians, particularly specialists, by enrolling them in their ACO, protecting their incomes and reducing their administrative burden.”

Julie Gould (Mazurkiewicz)

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