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.”
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