CMS released additional information Tuesday about its Track 1+ ACO model, which was first unveiled last month.
The new ACO model is one of the options under the Medicare Shared Savings Program and will qualify as an advanced alternative payment model in 2018 under the Medicare Access and CHIP Reauthorization Act.
Billed as a way to push more small physician practices and rural hospitals into adopting risk, Track 1+ operates as a hybrid of the MSSP's existing Tracks 1 and 3 by offering downside risk with limited exposure. The updates released Tuesday provide additional information about how much risk will be required under this track.
Here are four things to know about the new offering.
1. Track 1+ has a maximum shared savings rate of 50 percent, based on quality performance. This the same as Track 1, but lower than Tracks 2 and 3 of the program, which have maximum shared savings rates of 60 percent and 75 percent, respectively.
2. The loss sharing rate for Track 1+ ACOs is 30 percent. Normal Track 1 ACOs are in upside-only contracts. For Track 2 ACOs, this rate must be between 40 percent and 60 percent. For Track 3 ACOs, the loss sharing rate must fall between 40 percent and 75 percent. CMS plans to make lower levels of risk available to certain ACOs, such as physician-only ACOs or ACOs with rural hospitals.
3. If ACO composition falls into one of the three following categories, the risk arrangement will be benchmark-based:
- ACOs with participating hospitals in the inpatient prospective payment system, cancer centers or rural hospitals with more than 100 beds
- ACOs with participants owned or operated by a rural hospital with 100 or fewer beds that is not involved in the ACO
- ACOs with participating rural hospitals with 100 or fewer beds, owned or operated by a health system
Under this risk arrangement, the loss sharing limit is 4 percent of the ACO's updated historical benchmark. This is significantly lower than both Tracks 2 and 3, which phase up to 10 percent and start at 15 percent, respectively.
4. The second type of risk arrangement is revenue-based. If ACOs in the Track 1+ model do not fall into one of the three aforementioned categories, their loss sharing limit in 2018 would be 8 percent of Medicare fee-for-service revenue. This limit is subject to change in the following years based on requirements for MACRA's advanced APMs. If the nominal risk requirement revenue standard for advanced APMs increases, Track 1+ ACOs must also increase their loss sharing limit to continue in the advanced APM program. However, the revenue-based loss limit is capped at 4 percent of the updated historical benchmark, regardless of advanced APM requirements.
Find out more about Track 1+ risk requirements on the CMS fact sheet here. Read an overview of the model here.
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