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  #121  
Old 04-24-2019, 10:05 AM
PoisedGiraffe PoisedGiraffe is offline
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Originally Posted by Chaos Theory View Post
In practice I would say just follow Duncan's method and note the methodology comes from that source . If I recall correctly there has only been one MSSP question that provided age/sex factor as an adjustment in the last 6 years or so.

Also another inconsistency I found, Duncan seems to suggest MSR can be as high as 5% for small ACO, but the Commonwealth paper clearly states it grades down from 3.9%. Probably not a big deal for the exam but man, can these guys fight it out first?
Yeah that's probably the best approach. They can't really argue if you literally cite the source.

I noticed this too. Looks like the 5% applies if there are 3000 members, but other sources claim the minimum # of members if 5000. I suspect the 5% is used in the rare scenario where there were >5000 members when the plan enrolled in the program, but membership dropped below that in a performance year. Still weird
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  #122  
Old 04-24-2019, 01:42 PM
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Yeah that's probably the best approach. They can't really argue if you literally cite the source.
They don't need to argue. They can just mark it wrong. Imo you make a quick note then guess what the grader is thinking. Since they didn't provide demographics, you can guess they forgot it, and want you to risk adjust.
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  #123  
Old 04-24-2019, 02:22 PM
Latitude30 Latitude30 is offline
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Agree that is a little confusing on the risk adj.

I always read it as you only risk adj the benchmark period to the final benchmark year. Then you only adj for demographics from the benchmark to the performance year (and through subsequent performance years).

It was never clear to me to how to fully set the benchmark for the 2nd 3 year period.
I think the traditional method for benchmarking is the risk score doesn’t usually apply during the 3-year performance period of the contract (only age-sex) for benchmark adjusting. However, for the subsequent 3-year period’s benchmark for the contract renewal, it matters.

The concept is that changes in risk during a locked in 3-year contract don’t affect the ACO until renewing the contract. Think of it like a locked in fixed rate loan term. Until the loan term is up the borrowing rate isn’t affected if market rates rise or drop. For a new loan after that, the market rates over the recent term period affect the new fixed rate.

Thinking this through, this would mean an ACO planning to renew would most welcome unhealthy insureds in year 3 to get a risk adjusted higher benchmark so they can increase MSSP gains subsequent 3 years,

but in year 1 performance year when weight is only 0.1, they would want to have healthy selection get costs down save more. Hence it makes sense year 1 risk score is rebased from benchmark year 3 to remove this incentive to not want to include sicker insureds as a means to get more likely shared savings...

With the new ACO year weights being 1/3 1/3 1/3 this could then further help prevent ACOs gaming the system with risk score metrics in all performance years.

Last edited by Latitude30; 04-24-2019 at 02:38 PM..
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  #124  
Old 04-24-2019, 05:19 PM
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to some extent, i dont have enough time or effort to prepare for that level of confusing detail. That would be a 'partial credit' sub-question for me on the exam. When asked about re-basing, my goto answer in my head is:
•Use regional trend instead of national
•incorporate some of the savings from the first 3 year period into the benchmark for the 2nd period to avoid penalizing the ACO for savings from the first period.

im a 'pass with a 6' kinda guy. gotta focus my time on where the points are. My guess is that ACO MSSP question will be more related to that stupid MIPS AAPM- best to spend time memorizing that section for now.
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  #125  
Old 04-24-2019, 08:53 PM
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to some extent, i dont have enough time or effort to prepare for that level of confusing detail. That would be a 'partial credit' sub-question for me on the exam. When asked about re-basing, my goto answer in my head is:
•Use regional trend instead of national
•incorporate some of the savings from the first 3 year period into the benchmark for the 2nd period to avoid penalizing the ACO for savings from the first period.

im a 'pass with a 6' kinda guy. gotta focus my time on where the points are. My guess is that ACO MSSP question will be more related to that stupid MIPS AAPM- best to spend time memorizing that section for now.
Speaking of MSSP, how does the table on CMS slide 13 apply to anything? If quality is only 50% of the score, why does 0 quality meaning shared savings is 0*60% instead of (20% improvement + 30% advancing care + 0% quality) * 60% = 25%?
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  #126  
Old 04-24-2019, 09:05 PM
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These numeric questions are killing me. I don't think I can even write all these numbers in 6 minutes, nevermind punching hundreds of calculator buttons. And God forbid I waste any precious seconds thinking about the problem.
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  #127  
Old 04-24-2019, 09:56 PM
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Originally Posted by scott.ac View Post
Speaking of MSSP, how does the table on CMS slide 13 apply to anything? If quality is only 50% of the score, why does 0 quality meaning shared savings is 0*60% instead of (20% improvement + 30% advancing care + 0% quality) * 60% = 25%?
I think you are confusing MIPS APM scoring standard with MSSP ACO performance score, which is under advanced APM for two sided model.
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  #128  
Old 04-25-2019, 09:12 AM
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I think you are confusing MIPS APM scoring standard with MSSP ACO performance score, which is under advanced APM for two sided model.
I think it is hard to argue against me being confused at this point.

But slide 13 says (All Tracks), and slide 12 says "the following models are considered MIPS APMs" then shows "Share Savings Program Tracks 1,2,3"
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  #129  
Old 04-25-2019, 09:35 AM
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Speaking of MSSP, how does the table on CMS slide 13 apply to anything? If quality is only 50% of the score, why does 0 quality meaning shared savings is 0*60% instead of (20% improvement + 30% advancing care + 0% quality) * 60% = 25%?
that deck is garbage.

I think that 20/30/50 ratio is for MIPS scoring only if the provider is NOT part of a AAPM.

recall that MIPS is just the part B layer for scoring. ACO MSSP effectively function independently of MIPS, but are exempt if they are a 2-sided model that takes on 'more than nominal risk'. My goal is to memorize the requirements to be a AAPM.
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  #130  
Old 04-25-2019, 10:35 AM
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that deck is garbage.

I think that 20/30/50 ratio is for MIPS scoring only if the provider is NOT part of a AAPM.

recall that MIPS is just the part B layer for scoring. ACO MSSP effectively function independently of MIPS, but are exempt if they are a 2-sided model that takes on 'more than nominal risk'. My goal is to memorize the requirements to be a AAPM.
I guess I never stepped back and realized that, I was thinking of it all as integrated, thanks for the thought
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