The federal government’s changes to quality reporting rules governing accountable care organizations are receiving pushback on several grounds, including a lack of EHR interoperability.
Eleven provider organizations — including the American Hospital Association, American Medical Association and National Association of ACOs — have sent a letter to Department of Health and Human Services Secretary Xavier Becerra. In it, they detailed their concerns with the new quality reporting regulations for ACOs participating in the Medicare Shared Savings Program. These changes were announced as part of the 2021 Medicare Physician Fee Schedule, finalized at the end of last year.
One of the main sources of concern for providers is the move to electronic quality reporting, according to the letter. For this, ACOs must gather data from disparate EHRs. Nearly 70% of respondents to a recent National Associations of ACOs survey reported that their organization does not have software to assist with integrating and extracting quality data from their participating providers’ EHRs.
“The changes ignore the time it takes to adopt and implement electronic measures,” the organizations wrote in the letter. “Therefore, key policy changes and additional time are needed to ensure that ACOs can participate successfully, and that patient care is not negatively impacted.”
Further, ACOs must now report quality data for all patients regardless of payer. But, ACOs’ quality performance could be misrepresented as a result, the organizations wrote.
“ACOs treating vulnerable populations have a different mix of payers and patients, which could cause them to appear to have lower quality,” the letter states. “This will reduce their shared savings at a time they should be receiving more resources to combat [the] health equity issue and more support to remain on the path to value.”
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The provider organizations urged HHS to take action to ease the burdens resulting from the above changes. Their requests included delaying mandatory electronic quality reporting for at least three years and limiting reporting to ACO-assigned beneficiaries only, rather than all patients across payers.
If the government does not take steps to address their concerns, there may be unintended consequences, the organizations wrote. ACOs may drop clinicians, particularly specialists, small practices or those treating vulnerable populations, or ACOs could be deterred from entering the Medicare Shared Savings Program or leave the program entirely.
“…we urge CMS to reconsider the decisions finalized in December 2020 and work with our organizations and ACOs to find alternative approaches and a different timeline that will meet [the Centers for Medicare and Medicaid Services] and ACO needs,” the letter states.
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