Accountable Care Network FAQ

Answers for providers interested in the UC San Diego Health Medicare Shared Savings Program ACO

“An ACO is composed of groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated, high quality care to their Medicare fee-for-service beneficiaries. The Shared Savings Program rewards an ACO that improves the quality and cost efficiency of health care.”
– Centers for Medicare and Medicaid Services (CMS)

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MACRA | Evolving Payer Models: CMS Quality Payment Program

In MIPS, you can earn a payment adjustment based on evidence-based and practice-specific quality data. MIPS is the category that will apply to most physicians:

  • Moves Medicare Part B clinicians to a performance-based payment system
  • Provides clinicians with flexibility to choose the activities and measures that are most meaningful to their practice
  • Reporting standards align with Advanced APMs wherever possible

Key Takeaway

Positive adjustments are based on the performance data of the performance information submitted, not the amount of information or length-of-time submitted. You can submit 90 days of information with great quality and receive a higher percentage than someone who submitted all year with acceptable quality.

Potential Financial Rewards

Although MACRA creates separate paths for payments under the Medicare Physician Fee Schedule (PFS), these paths are in addition to, not in replacement of, the PFS.

MACRA replaced SGR with a schedule that will increase baseline Medicare Part B payments by 0.5% per year until 2019. The first payment adjustments will be based on performance year 2017 and will reflect in your 2019 Medicare payments.

If you participate in an Advanced APM, you will receive a + payment adjustment of 5% every year, beginning in 2019. 

PQRS Payment Reminder: PQRS will be referred to as a “legacy program.” The last performance year of this program was 2016. If you participated this last year, your payment adjustment will take place in 2018. As a reminder, this is not associated with your 2018 MIPS performance.