Written by Accountable Care Options, LLP
The Centers for Medicare and Medicaid Services finalized rules for its
payment program on Nov. 2. They affect practices in advanced alternative
payment models, including accountable care organizations, or ACOs.
Practices can earn annual incentives up to 5 percent if they are in
ACOs that accept a financial risk for excessive costs in return for a
greater percentage of the savings generated. That category includes
Medicare Shared Savings Tracks 2 and 3, Next Generation ACO models,
Comprehensive ESRD Care Model, Comprehensive Primary Care Plus model and
Oncology Care Model.
Practices that receive 25 percent of
Medicare payments or see 20 percent of Medicare patients in 2017 through
an advanced payment model are eligible to receive a 5 percent incentive
payment in 2019.
The good news is that practices in those ACOs
have most of the reporting work done for them. Physicians can focus
their time and attention on delivering effective, efficient care. They
will still need to attest what's called Advancing Care Information
measures; they replace meaningful use.
The best way to score
well in this area is to perform a security risk analysis - a HIPAA
analysis of electronic health records. Evaluate the integrity of your
system and the structures that house them. If you discover a security
risk, then establish a plan and act on it.
To do well overall,
a practice should align itself with an ACO that ranks in the 90th
percentile or higher in quality and had a positive 2015 adjustment in
the value modifier; the latter was based on measures of quality of care
and cost containment.
Practices in the advanced payment model
that efficiently treat specific cases and diseases and have also
generated shared savings will also earn a positive adjustment. The
incentive payment will be delivered directly to the practitioner.