The Centers for Medicare and Medicaid Services (CMS) gave additional details about the Medicare Accountable Care Organization Track 1+ Model it announced last month, which is intended to encourage more small physician practices and small rural hospitals to “advance to performance-based risk,” according to the agency. 

An option under the Medicare Shared Savings Program (MSSP) starting in 2018, the new model will qualify as an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act (MACRA). Participants in the ACO Track 1+ Model will have downside risk, which they would not have in MSSP Track 1, but not as much downside risk as in MSSP Tracks 2 or 3.

The maximum shared savings rate for Track 1+ is 50 percent based on quality performance, compared with 60 percent for Track 2 and 75 percent for Track 3. The loss sharing rate for Track 1+ is 30 percent, versus 40 to 60 percent for Track 2 and 40 to 75 percent for Track 3. CMS said lower levels of risk may be available for select participants, such as physician-only ACOs and those with small, rural hospitals.

Certain qualifying ACOs in Track 1+ will have a benchmark-based risk arrangement, with a loss sharing limit of 4 percent of the ACO’s updated historical benchmark. Other ACOs in Track 1+ will have a revenue-based risk arrangement, starting with a loss sharing limit of 8 percent of their Medicare fee-for-service revenue in 2018. 

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