“So I think that some of the uncertainty that was there in 2017 with the new administration, I think a lot of that has disappeared, and there’s a clear direction that MACRA is staying and that there’s still really strong financial reasons to be in an ACO, even apart from all of the clinical and patient experience sides of things.”
Assisting, protecting physicians
One of the financial reasons to consider joining an ACO is that CMS gives them preferential treatment under MIPS, Gronniger says.
“We see a lot of hospitals that are using this program to protect their physicians in their clinical networks from penalties under the MIPS program, using it as an opportunity to embrace their physician networks,” Gronniger says. “There’s certainly also revenue-generating opportunities and shared savings, but that’s usually like a secondary issue for a lot of the providers we work with.”
Gronniger served as CMS deputy chief of staff until the end of the Obama administration, but that hasn’t stopped him from criticizing some of his own team’s work product.
“I am no fan of the MIPS program, even though I helped to write the rules for it,” he says. “I think there are a lot of problems with the MIPS program. One of the benefits of an ACO is that it takes you out of the worst elements of the MIPS program, honestly. I think that the MIPS program, as it’s currently constituted, is burdensome for clinicians and that it can’t really be easily repaired.”
Gregory M. Whisman, MD, serves as chief medical officer for OhioHealth Venture LLC, a new MSSP ACO that serves OhioHealth’s employed physicians group and independent practices that are part of the system’s clinically integrated network.
Before OhioHealth Venture was formed, many of OhioHealth’s employed practices were part of Comprehensive Primary Care Plus (CPC+), meaning they were already part of an advanced alternative payment model (Advanced APM) that kept them prepared, Whisman says. Small practices, however, were feeling the strain.
Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.