The report finds that being part of an ACO allows clinicians to be rated as a group for a key measure to determine Medicare reimbursement.

Published Online: March 30, 2017

Mary Caffrey

Joining an accountable care organization (ACO) could help clinicians raise key Medicare performance scores up to 30%, which boosts their chances of higher reimbursement relative to competitors, according to a new report from Caravan Health.

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 what payments will look like for clinicians inside and outside ACOs under the Medicare Access and CHIP Reauthorization Act (MACRA, passed in 2015 to push healthcare toward value-based payment.

Under MACRA, performance data reported from 2017 will be used to calculate payments in 2018. CMS has worked to ease the transition to value-based payment, allowing clinicians to select how quickly they want to take on the associated risk. In fact, reporting a small amount of data for 2017 can help clinicians avoid penalties.

The report centers on the Merit-Based Incentive Payment System, or MIPS, which is expected to be the reimbursement path that most clinicians use in the early years of MACRA. Those practices that are further along in working with value-based payments may instead pursue reimbursement under the advanced alternative payment model (APM) track.

However, MACRA not only pushes clinicians further away from fee-for-service, but also calls for clinicians to be rated against one another. For those who seek higher payments, this factor further separates those taking part in ACOs from those who are not, the report finds, since clinicians in ACOs will be rated together for 1 key measure.

READ MORE: Joining an ACO Key to Success Under MACRA, Report Finds