Reporting to Scoring: MSSP Quality Overview

Introduction — MSSP quality overview

In the 2021 Medicare Physician Fee Schedule (MPFS) Rule, CMS finalized a major overhaul of the quality
reporting and assessment structure for Medicare Shared Savings Program (MSSP) ACOs, transitioning to the APM Performance Pathway (APP). CMS created the APP to better align quality measurement approaches for MSSP with the Quality Payment Program (QPP) Merit-Based Incentive Payment System (MIPS) quality reporting and assessment approaches. Part of this transition includes CMS’s plans to retire the Web Interface (WI) reporting option and require all ACOs to report electronic clinical quality measures (eCQMs) or MIPS clinical quality measures (CQMs) beginning in Performance Year (PY) 2025.

ACOs are evaluated on a number of quality measures, which allows CMS to assess the quality of care being provided to patients served by ACOs. These quality evaluations also determine whether an ACO is eligible to keep a portion of any financial savings it may generate, which is shared with CMS. Conversely, if shared losses are owed to CMS, the quality score determines the portion of losses the ACO must pay to CMS. MSSP ACOs are not required to report additional quality measures for MIPS beyond those included in the APP set that are scored for both MSSP and MIPS quality assessments (when applicable). ACOs in the first year of their contracts are provided with full credit so long as the ACO completely and accurately reports all quality measures to CMS (pay-for-reporting). Each subsequent year, the ACO will be assessed on quality measure performance for each prescribed measure in the measure set (pay-for-performance).