Analysis: Track 1 ACOs Set for Positive MIPS Payment Adjustments

An analysis by the National Association of Accountable Care Organizations (NAACOS) revealed that 2017 Track 1 ACOs are likely to score well above the MIPS performance threshold, and most above the MIPS exceptional performance threshold, thereby receiving a positive MIPS payment adjustment.

Last week, NAACOS shared results of its analysis of ACO performance in the Quality Payment Program of the Merit Based Incentive Payment System (MIPS) created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Working with NAACOS, the consulting firm of Dobson DaVanzo & Associates, modeled the Alternative Payment Model (APM) scoring standard rules applicable to ACOs in MIPS and applied historical Track 1 ACO quality data to project 2017 ACO MIPS scores and their corresponding payment adjustments in MIPS.

In, all there are more than 400 Track 1 ACOs, which is CMS’ lowest-risk type of ACO. Other ACO tracks involve two-sided risk but are far less popular.

NAACOS is the largest association of ACOs, representing more than 3.72 million beneficiary lives through 260 Medicare Shared Savings Program (MSSP) ACOs, Next Generation, and commercial ACOs.

The analysis indeed found that all 2017 Track 1 ACOs are likely to score well above the MIPS performance threshold, and most above the MIPS exceptional performance threshold, thereby receiving a positive MIPS payment adjustment. However, the overall ease at which MIPS clinicians may earn positive adjustments, coupled with budgetary restraints, indicates that most payment adjustments may be relatively small, ranging from 0.4 percent to 2.6 percent of qualified providers’ Part B expenditures, according to the analysis.

There has been some positive research momentum on ACOs of late. An August analysis from the U.S. Department of Health and Human Services’ (HHS) Office of the Inspector General found that CMS ACOs participating in Medicare Shared Savings Program reduced spending by nearly $1 billion in the first three years of the program. In its analysis, OIG found that ACOs that were in the program longer were more likely to reduce spending and by greater amounts.

What’s more, a recent Health Affairs analysis found that nearly 90 percent of survey respondents reported that they had at least one upside-only shared savings contracts, 50 percent had at least one active contract that included downside risk of either shared savings/shared losses (38 percent), or capitation (12 percent). And, 47 percent of those surveyed indicated that they were considering participating in, or already have, firm plans to participate in at-risk arrangements, with 47 percent pursuing shared savings/shared losses, and 38 percent pursuing capitation.