On July 19, 2021, the Centers for Medicare and Medicaid Services (CMS) released the 2022 Physician Fee Schedule Proposed Rule, much to the anticipation of Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) across the country. Prior to this release, there was a concerted effort from ACOs to address issues surrounding electronic clinical quality measure (eCQM) requirements that will be implemented in 2022. This proposed rule indicates that CMS may delay the eCQM requirements for two more years but will require a demonstration of good faith efforts to begin eCQM utilization.
CMS has made very clear their indication to move all quality reporting to a standardized set of measures and reporting mechanisms. Currently, this spans across all MIPS eligible clinicians, which is most clinicians who bill Part B Medicare. The vehicle: electronic clinical quality measures. CMS has implemented a standard reporting set and required i) clinicians to utilize an electronic health record (EHR) that can report on these measures and ii) the EHR vendors to construct such reporting capabilities.
But what works for most clinician practices regarding quality reporting does not work for most ACOs. As a convener of different health care systems, an ACO must report quality measures across multiple EHRs. Among the many issues, the data output from disparate EHRs will not always be similarly constructed, nor will patient duplicates be easily identified. This makes it difficult for ACOs to accurately report quality measures.
Additionally, many ACOs are structured as a separate entity that does not employ health care providers. These ACOs are independent companies with no EHR internally, as they solely administer and operationalize the ACO contract. eCQMs require data completeness, meaning, that the quality reporting must measure 70% of all patients within an EHR, no matter the payer. Legally, this creates problems for ACOs who have contracted with health systems for data collection and reporting on a specific population of patients, not all patients found within an EHR.
Proposed Quality Changes
Due to extensive advocacy efforts, CMS has proposed to delay the requirement for ACOs to use eCQMs for quality measure reporting in 2022 and freeze the MSSP quality performance threshold for an additional year.
For quality reporting for 2021, CMS is proposing to allow ACOs to choose to report quality either via the Web Interface to which most ACO are accustomed. Or ACOs can report via eCQMs or MIPS CQMs. MIPS CQMs differ from eCQMs because they require a third-party vendor to manually abstract data from the EHR.
For 2022 and 2023, CMS is proposing to allow ACOs to choose between the Web Interface measures plus reporting only one measure via eCQMs/MIPS, which will not be scored, or reporting entirely via eCQMs and MIPS CQMs.
CMS is incentivizing ACOs who choose to report via eCQMs/MIPS CQMs by reducing the performance standard threshold. For the ACO to retain any savings it generated in the model, it only has to meet 30th percentile of all MIPS final quality scores with one of the three required measures. If passed, the ACO gets the full amount of the savings it generated for their level of participation. The Web Interface measures performance threshold will be a higher and harder standard to hit. Thus, incentivizing ACOs to move to the new reporting method.
In 2024, CMS is proposing that all ACOs must report measures via eCQMs or MIPS CQMs while raising the performance standard to 40th percentile for all MIPS final quality scores. CHESS awaits the publication later this year of the Final Rule for more direction and clarity around the requirements.
Although there are many unknowns as to how ACOs will aggregate, deduplicate, and submit eCQMs to CMS, CHESS applauds CMS and feels that this proposed rule is a step in the right direction. It indicates that CMS is listening and wants to partner with ACOs to make the program successful as health systems continue their value-based care journey.