PQRS and ACO Reporting
MaineHealth has been accepted as a Medicare Shared Savings Program (MSSP) participant effective July 1, 2012. MMC PHO providers will now be participating as an Accountable Care Organization (ACO) in the MSSP. This is good news for those now participating in the CMS Physician Quality Reporting System (PQRS) because providers would no longer need to submit information to CMS for PQRS reporting.
PHO providers will automatically qualify for PQRS by virtue of the MMC PHO submitting the ACO quality measures. If you are currently considering establishing a process in your office to submit information to PQRS we would encourage you to hold off until we are clear about our participation with the MSSP.
If you have any questions please contact Sandi Daigle at email@example.com or 482.7067.
ACO and Member Performance Review Program
The health care industry has become increasingly difficult to navigate. There are more numerous quality programs than ever before, more complex contractual relationships, increased administrative requirements, ACA, ACO, PCMH, NCQA, CMS, BTE…
The Community Physicians of Maine developed the Member Performance Review Program with these requirements in mind. The intent of the program is not to be punitive, but to set standards for membership that will position members for success in the current and future health care environment. Accountable Care and achievement of the triple aim (better care for patients, better health for populations and reduced costs of care) are the beacons that guide the work and tie these seemingly disparate and distracting external programs together.
As we move forward as an ACO, we will continue to build upon the existing Member Performance Review Program with the goal of supporting members in pursuit of the Triple Aim and aligning with other program requirements. Your input and engagement in this work is critical to our success as an ACO.
If you have any questions about the Member Performance Review Program please contact Sandi Daigle at firstname.lastname@example.org or 482.7067.
Medicare Shared Savings Program- Quality Reporting
MaineHealth has been accepted by CMS as a participant in the Medicare Shared Savings Program (MSSP). PHO members will be responsible for reporting on 33 quality measures. The Community Physicians of Maine (CPM) anticipated that need and incorporated the measures into the 2012 Member Performance Review Program utilizing the specifications released by CMS (below).
The technical specifications have not yet been released so there is not enough detail to program electronic systems to capture the data fully. The technical specifications are due in the fall. As we learn more, we will provide more detail including specifics on the process for reporting data to CMS.
What quality measures do we need to collect?
EHR and registry users that want to initiate discussions with their vendors, may find the following documents helpful: