Audacious AI Blog

ACOs are MACRA Stewards, even though they never asked to be

You didn't ask for it. You didn't even agree to it. But you are fiscally responsible

MACRA came intStewardshipo law after ACOs came into existence.  Then, the MACRA regulations put ACOs explicitly in charge of Quality.  That was what you were already doing.  But PI is another large portion, and although each clinic is "responsible" for their own results, the ACO is where results are aggregated, and everyone shares in the same aggregation.   Member clinics look to the ACO  for a good overall PI / MIPS score, whether or not you asked for it.  


The dollars are as great as MSSP Shared Savings (or Losses)

Some years, ACOs don't have shared savings to distribute, but every year MACRA imposes penalty or reward.  And once MACRA hits full swing, the potential positive adjustments are +19% of Medicare receipts, and penalties -9%.  When you consider overall Part B Billings, MACRA can be bigger then Shared Savings or Losses, even in a good year for the ACO.  


No one other than you can manage it

Every clinic in the ACO is individually responsible for their own MIPS PI submissions.  But here's the thing.  Those submissions all roll up to an ACO score, and every clinic inherits the rolled up aggregate.  So a clinic that performs well can be dragged to a lower level by other ACO member clinics over which they have no control ... and with which they may not have any relationship at all.  

The ACO is the only entity with relationships across all clinics.  In fact, the clinics often expect that the ACO will help them out with MACRA (whether you have ever promised to do so).  We believe that Monthly MACRA analysis is necessary to truly make a difference. 

You are tempted to (erroneously) claim that you don't have the ability to know

Because you don't create or submit MIPS PI data for your clinics, you have to ask for visibility.  But you might be surprised how willing providers are to share their data, if you are willing to help.  Especially once you explain that your influence with everyone else can make money for each of them.  

Providers don't hold you accountable (yet). But they will, eventually

MIPS scores have been an abstract concept, until this year.  But now, 2019 Medicare Payments start to reflect the results of MACRA work you did in 2017.  Envision, for a moment ... a cardiology group, billing $10M in Medicare.  Further envision that cardiology group as an excellent user of EHR technology, and having wonderful quality scores.  Finally, imagine that the overall ACO aggregate scores are less than what the cardiology group could have earned on its own.  At some point, those providers will look to the ACO for an explaination of why they earn less than they would have earned without you.  

You can turn it all to a huge provider relations (and financial) bonanza

A High-Performance Monthly MACRA program can show providers your level of compassion for their Medicare Revenues.  

If you dedicate the right resources, tools, and people to MACRA, you will earn provider gratitude, and assure that you don't lose providers, for reasons completely apart from your core mission.  You never asked to be responsible for MACRA, but your providers won't necessarily see it that way if things go wrong.  

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MACRA Monitor is an subscription-based product from C3 Partners that combines a MACRA database with dedicated Concierge service for ACOs and other complex organizations