Health Care Efficiency Through Flexibility

Summary#

This bill changes how quality measures are reported for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. For performance years 2025 through 2029, the Secretary must make specific collection types available for each required quality measure: electronic clinical quality measures, MIPS clinical quality measures, and Medicare Clinical Quality Measures for ACOs. The bill also clarifies that an ACO’s submitted data cannot be judged unrepresentative solely because it omits data from one or more ACO participants if the ACO otherwise meets data completeness rules and shows that a participant could not collect data through the chosen collection type. The bill allows the Secretary to implement these rules by program instruction.

The bill also creates a pilot program for performance years 2028 through 2032. The Secretary will select ACOs that apply to the pilot. Selected ACOs must report two Secretary-specified measures through a digital quality measure collection type. The Secretary may waive other reporting requirements for those ACOs for that year. Data submitted under the pilot, or data on measures the ACO is not required to report that year, may not be used to determine whether the ACO met quality performance standards or to calculate quality scores for ACO participants. The Secretary must provide technical assistance to pilot participants and publish an analysis, recommendations, and a proposed timeline by December 31, 2032.

What it means for you#

  • If you are an ACO: The bill requires that multiple electronic collection options be available for required quality measures in 2025–2029. You may be able to exclude data from a participant that could not collect data using your chosen collection type without having the submission called unrepresentative, if you meet other completeness rules and can show the participant’s inability to collect the data. If you join the 2028–2032 pilot, you will report two measures using a digital collection type and may be waived from reporting other measures for that year. Pilot data will not count toward quality determinations or individual ACO participant quality scores for those measures.
  • If you are a provider within an ACO: The bill recognizes that some ACO participants may be unable to collect data with a particular collection type and allows ACOs to demonstrate that inability when submitting data.
  • If you are a patient or other stakeholder: The bill focuses on how ACOs report quality data and sets up a pilot to test digital reporting methods. The bill requires public reporting of the pilot’s analysis and recommendations by the end of 2032.

Expenses#

No publicly available information on costs or budget effects is included in the bill text or metadata.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.