Having made allowances in Quality Payment Program (QPP) reporting for practices affected by recent natural disasters, CMS is now giving Medicare accountable care organizations (ACOs) a similar break in both their QPP reporting and in their Shared Savings program scoring.
In the QPP rule released Nov. 2, CMS created an “extreme and uncontrollable circumstance” exception for reporters in districts judged to be affected by Hurricanes Harvey, Irma and Maria (and others recently for those affected by the California wildfires).
On Dec. 22, CMS issued an interim final rule with comment period adding a similar policy for participants in their ACO Shared Savings programs who share risk – that is, those on Tracks 2 and 3.
Because “ACOs participating in a two-sided risk model are required to share losses with the Medicare program when expenditures over the benchmark exceed the minimum loss rate,” said CMS in the rule, stakeholders expressed concern that the disasters would unfairly impact these ACOs and “existing Track 2 and Track 3 ACOs may be unable to remain in a two-sided risk track if they are held fully accountable for repaying shared losses associated with these disasters.”
Therefore, CMS is "aligning the automatic extreme and uncontrollable circumstances policies under the Shared Savings Program with the policy established under the Quality Payment Program," the agency announced.
Based on current records, CMS will determine "whether 20 percent or more of the ACO’s assigned beneficiaries resided in counties designated as an emergency declared area in performance year 2017" and, if so, “the ACO’s minimum quality score will be set to equal the mean Shared Savings Program ACO quality score for all ACOs for performance year 2017."
To give affected ACOs some idea of what to expect, CMS reported the previous year’s mean score was 95%. If these ACOs report quality scores anyway, CMS will give them the higher score between that and the extreme-measures score. Those who get the extreme-measures score cannot claim bonuses
If the ACO is reporting as a merit-based incentive payment system (MIPS) APM in the reporting period, they will receive a zero percent score in the MIPS quality performance category. "However, these MIPS-eligible clinicians would receive a score of 100 percent in the improvement activities (IAs) performance category, which would be sufficient for them to receive a 2017 MIPS final score above the performance threshold" and "would result in at least a slight positive MIPS payment adjustment in 2019."
As far as the ACO’s score in the Shared Savings program goes, CMS said, "we will reduce the ACO’s shared losses" based on two factors: the percentage of the total months in the performance year affected by the extreme and uncontrollable circumstance and the percentage of the ACO’s assigned beneficiaries who reside in an area affected by an extreme and uncontrollable circumstance.
Example: If an ACO has a $100,000 loss for the year, and a disaster affected 25% of its beneficiaries for three months (that is, 25%) of the year, the formula for the adjustment would be $100,000 x 25% x 25% -- thus, $6,250 knocked off their reported loss.
Comments on the rule are invited through 5 p.m. on Feb. 20, 2018.