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New ACO model for small rural hospitals

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CMS has come out with  details of its newest Accountable Care Organization (ACO) offering in the Medicare Shared Savings Program — Track 1+ — intended to push more small physician practices and small rural hospitals to adopt risk-based systems.

Becker’s Hospital Review has come up with five things to know about the Track 1+ Model. Here’s our edited version of the list.

1. “The Track 1+ Model is a hybrid of Tracks 1 and 3 of the MSSP. It lets practices begin to take on some downside risk, but limits exposure. The downside risk in Track 1+ is more limited than that of Tracks 2 or 3. ”

2. “It qualifies as an advanced alternative payment model under the Medicare Access and CHIP Reauthorization Act. Clinicians can enroll in the program to start in 2018. Those who participate may be eligible to earn the lump sum incentive payment for Medicare Part B payments under the advanced APM track beginning in the 2018 performance year. By adding this option as an advanced APM under MACRA, the agency expects an additional 70,000 physicians to qualify for incentive payments in 2018.

3. “The model follows that of MSSP Track 1 with a few key differences. The elements of Track 3 included in the new model are as follows:

  • Prospective beneficiary assignment.
  • Option for symmetrical thresholds for shared savings and losses.
  • Option to use the three-day skilled nursing facility. waiver, allowing ACOs to admit patients to SNFs without a minimum three-day inpatient hospital stay.

4. “The program has a 50 percent maximum shared savings rate. For perspective, Track 2 has a 60 percent MSR and Track 3 has a 75 percent MSR. Track 1+ has a fixed 30 percent loss sharing rate and the maximum level of downside risk will vary. Depending on the ACO composition, the maximum loss limit will be capped at 8 percent of Medicare fee-for-service revenue or 4 percent of the updated historical benchmark. Lower levels of risk may be offered for ACOs with independent physicians or small rural hospitals.”

5. “The application process will follow the same timeline as all other MSSP applications. CMS has not yet finalized application details, but interested ACOs will need to submit a letter of intent in May 2017. New ACOs and Track 1 ACOs will be eligible to apply. In addition to 2018, CMS plans to offer the model in 2019 and 2020.”

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