Blog
Small Practices, Big Penalties: Toward a Fairer, Data‐Grounded Payment Model
Smart ACO leaders are leveraging 2025’s triple convergence—mandatory eCQM adoption, heightened CMS compliance, and unprecedented Medicaid funding cuts—not just to stay compliant, but to gain a competitive edge. In the face of evolving quality reporting requirements, complex multi-EHR data aggregation, and the fallout from over $1 trillion in Medicaid cuts, leading Accountable Care Organizations are strategically investing in robust data infrastructure, specialist engagement, and technology upgrades to outperform market peers and drive both quality improvement and financial sustainability through the remainder of 2025 and beyond.
APP Plus Without the Headaches: How to Aggregate, De-duplicate, and Hit Benchmarks Across Every Site
Smart ACO leaders are leveraging 2025’s triple convergence—mandatory eCQM adoption, heightened CMS compliance, and unprecedented Medicaid funding cuts—not just to stay compliant, but to gain a competitive edge. In the face of evolving quality reporting requirements, complex multi-EHR data aggregation, and the fallout from over $1 trillion in Medicaid cuts, leading Accountable Care Organizations are strategically investing in robust data infrastructure, specialist engagement, and technology upgrades to outperform market peers and drive both quality improvement and financial sustainability through the remainder of 2025 and beyond.
Beyond Compliance: How Smart ACO Leaders Are Turning 2025's Triple Threat into Competitive Advantage
Smart ACO leaders are leveraging 2025’s triple convergence—mandatory eCQM adoption, heightened CMS compliance, and unprecedented Medicaid funding cuts—not just to stay compliant, but to gain a competitive edge. In the face of evolving quality reporting requirements, complex multi-EHR data aggregation, and the fallout from over $1 trillion in Medicaid cuts, leading Accountable Care Organizations are strategically investing in robust data infrastructure, specialist engagement, and technology upgrades to outperform market peers and drive both quality improvement and financial sustainability through the remainder of 2025 and beyond.
What is a Gap Closure Report: Optimizing Tools for ACO Success
Gap closure reports are the strategic intelligence that separates high-performing ACOs from the rest. These reports identify patients who have missed critical preventive care, directly impacting HEDIS scores and shared savings. For ACOs, mastering gap closure is not just about improving quality metrics; it's about designing powerful incentive structures that motivate care coordination teams. Learn how to leverage technology, optimize workflows, and implement reward systems that drive performance, enhance patient outcomes, and achieve sustainable financial success in value-based care.
Emergency Department Teams and the Cost Category: What MIPS Doesn’t Explain But You Should Know
Did you know 30% of your MIPS score hinges on cost performance—including hidden ED episode measures? This guide breaks down how CMS calculates ED visit costs, where your team’s workflows unknowingly impact scores, and 5 proven strategies to optimize both care and reimbursement.
CMS’s ACO PC Flex Model and Evolving REACH Requirements: What ACO Leaders Need to Know Now
CMS’s 2025 ACO PC Flex Model offers upfront and monthly payments to stabilize primary care funding, while ACO REACH prepares for stricter 2026 benchmarks and risk adjustments. ACOs must navigate financial modeling, care transformation, and compliance—turning regulatory shifts into strategic advantages. Discover actionable steps to optimize revenue, manage risk, and stay ahead.
What CMS’s CY 2026 MSSP Proposed Rule Means for ACOs
The CY 2026 Physician Fee Schedule Proposed Rule introduces major changes for ACOs, including accelerated risk progression, revised quality metrics, and new beneficiary requirements. Learn how these updates impact your financial strategy and operational workflows—and how to prepare before the September 12 comment deadline.
September 2025 CMS Preview Period Reopened: What LTCHs and IRFs Need to Know About the Corrected Quality Reports
CMS has reopened the September 2025 Preview Period for LTCH and IRF quality reporting. Learn what's changed, which measures were corrected, and what providers must do by the August 28 deadline to protect their Medicare Compare scores.
MSSP and ACO Proposed Changes 2026: What Clinicians Need To Know About Proposed Rule Changes
Starting in 2026, CMS is introducing major updates to the Medicare Shared Savings Program (MSSP) that will impact ACO participation, risk models, quality reporting, and cybersecurity protections. Key changes include a shorter one-sided risk period (5 years instead of 7), relaxed patient minimums, simplified quality reporting, and new safeguards against cyberattacks. ACOs must prepare now to adapt to these shifts and maximize performance under the new rules.
Strategies for Engaging Clinicians in ACO Shared Savings Meetings
With the passage of the One Big Beautiful Bill Act (OBBBA), ACOs must prioritize clinician engagement in Shared Savings Program (SSP) meetings to maximize performance under new Medicare payment structures. This guide outlines 7 actionable strategies—from aligning incentives with 3.8% APM payment bumps to leveraging peer-to-peer learning and streamlined data insights—to boost participation, improve outcomes, and drive shared savings.
PROPOSED 2026 ACO UPDATES Shared Savings Program Participants
The 2026 CMS proposed rule introduces major updates for ACOs in the Medicare Shared Savings Program (MSSP), including mandatory APP reporting, a stronger push toward digital quality measures, and higher performance thresholds. Key changes also include revised benchmarking, beneficiary attribution adjustments, and expanded Promoting Interoperability requirements. ACO leaders should prepare for increased digital reporting demands while taking advantage of new flexibilities—especially for rural and smaller ACOs. Stay informed and ready for compliance ahead of the final rule.
2026 MIPS Proposed Rule: What’s Changing with Traditional MIPS?
The Centers for Medicare & Medicaid Services (CMS) has proposed key updates for the 2026 MIPS performance year, including unchanged category weights, a stronger push toward digital quality measures (dQMs), and adjustments to measure inventories and performance thresholds. Clinicians and administrators should prepare for evolving MIPS Value Pathways (MVPs), streamlined reporting, and increased digital reporting requirements. Stay ahead by reviewing the proposed changes and ensuring compliance before the final rule takes effect.
Action Guide: CMS’s 2025 Third-Party Intermediary Policy Changes
Discover CMS’s 2025 third-party intermediary policy changes for MIPS providers and get clear, actionable steps to update vendor agreements, test workflows, and meet deadlines.
Automatic Re-Weighting Policies in CY 2025: What Every MIPS Provider Should Know
Automatic reweighting in MIPS 2025 doesn’t mean less work—it means smarter strategy. Hospital-based, small practice, rural, and non-patient-facing clinicians must understand how reweighting impacts their scores. Missing key deadlines or misreporting could mean lost incentives. Learn which categories shift, who qualifies, and how to optimize your MIPS performance.
What Is a MIPS Security Risk Assessment (SRA)?
A Security Risk Assessment (SRA) isn’t just another checkbox for MIPS—it’s a critical safeguard for your practice’s data and Medicare compliance. By identifying vulnerabilities in how you protect patient health information (PHI), an SRA helps you avoid breaches, fines, and lost trust—while securing full Promoting Interoperability points. Follow our step-by-step guide to streamline your SRA process and stay ahead of CMS requirements in 2025.
Meeting the Minimum PI Data Submission Requirements (A Tutorial)
Learn how to meet the 2025 Promoting Interoperability minimum data submission requirements under MIPS. This step-by-step guide helps providers and practice managers ensure compliance, avoid penalties, and optimize EHR reporting.
MIPS Metrics in Motion: Why Emergency Medicine Needs a Custom Approach
Emergency medicine isn't built for traditional MIPS metrics. Learn why EDs need a custom approach to MIPS reporting and how your team can optimize quality, cost, and improvement activities for better performance and fewer penalties.
July 5, 2025: The MIPS Deadline You Can’t Afford to Miss for Promoting Interoperability
MIPS-eligible physicians: July 5, 2025, is your last chance to begin the 180-day Promoting Interoperability performance period. Discover how to optimize your PI score and download a readiness checklist to ensure you're audit-ready.
MIPS for Specialists: How to Maximize Performance with Your Patient Population
Specialists face unique challenges under MIPS, but with the right approach, they can avoid penalties and even earn bonuses. Here’s how:
Quality (30% of score): Report at least six specialty-specific measures, including one outcome or high-priority measure. Use EHR-integrated reporting and benchmark against peers.
Improvement Activities (15%): Choose activities that align with your workflow, such as chronic care management or patient education programs.
Promoting Interoperability (25%): Ensure EHR compliance with e-prescribing, data sharing, and patient portals. Check for potential hardship exemptions.
Cost (30%): Focus on efficient practices, minimize unnecessary procedures, and review CMS cost reports.
Avoid Common Mistakes:
Skipping specialty-specific measures
Overlooking Improvement Activities
Missing CMS feedback or deadlines
Pro Tip: Use a MIPS registry for real-time tracking and automated reporting.
Understanding Topped-Out Measures and Their Impact on Your 2025 MIPS Scores
Topped-out measures—where most clinicians score near the benchmark ceiling—can hurt your MIPS Quality score even if your care is excellent. In 2025, CMS is adjusting scoring, removing outdated measures, and adding new opportunities. Here’s how to adapt:
Key Changes:
No More 7-Point Cap: Topped-out measures in specialty sets can now earn full points if meaningful variation exists.
Annual Topped-Out List: Check the Federal Register (published June 1) for measures flagged for removal or adjustment.
New High-Value Measures: CMS added 7 new measures, including patient-reported outcomes (e.g., pain post-chemotherapy).
Pro Strategies:
✔ Diversify: Replace topped-out measures with high-weight alternatives.
✔ Track in Real Time: Use dashboards and weekly huddles to monitor performance.
✔ Leverage Registries: Ensure your QCDR/EHR reflects 2025 benchmarks and test submissions early.
Act Now: Don’t let topped-out measures drag down your score. Innovate with new measures, optimize reporting, and protect your incentives.