MSSP ACOs would have seen $966M in additional payments by assuming greater risk in 2016

Medicare ACOs would have earned $966 million in additional net payments from participating in advanced alternative payment models in 2016, updated Avalere data revealed.

Under the Quality Payment Program, physicians who join ACOs incorporating downside risk are eligible for a lump-sum bonus equal to 5 percent of their Medicare Part B expenditures. This year, ACOs can participate in the Medicare Shared Savings Program Track 1+, which qualifies providers for the 5 percent bonus but offers limited exposure.

In its analysis, Avalere examined how non-risk bearing Track 1 ACOs would have performed under the new Track 1+ risk-bearing model — and the financial implications of being eligible for the 5 percent bonus. Avalere found 372 ACOs, or 91 percent, would have financially benefited from bearing risk and gaining the bonus. However, if the 5 percent bonus was not available, only 22 ACOs, or 5 percent, would have made net positive earnings under Track 1+.

Across ACOs, the 5 percent advanced APM bonus would have totaled $1.2 billion, the ACOs would have incurred $263 million in shared losses, and the ACOs would have earned an additional $30 million in shared savings payments. Taken together, the net payments would have totaled $966 million by switching from Track 1 to the Track 1+ model, Avalere reports.

"CMS is eager to encourage more ACOs to take on performance-based risk," said John Feore, director at Avalere. "With the incentive payments and increasing comfort with the Medicare Shared Savings Program, risk-based ACOs will continue to grow in the coming years."

More articles on ACOs:
Aledade extends Utah ACO to 4,000 Regence BCBS members
Creating interoperable ACOs: Overcoming four common barriers
7 key takeaways from CMS' latest Medicare Shared Savings report

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