CMS unveils Track 1+ ACO model details: Top 5 things to Note

This week CMS (Centers for Medicare and Medicaid Services) revealed the details of its latest ACO offering in the Medicare Shared Savings Program — Track 1+ — intended to emphasize smaller physician practices and small rural hospitals to adopt risk.

To know about the Track 1+ Model, here are the top five things to note:

1. It qualifies as an advanced alternative payment models (APMs) under the MACRA (Medicare Access and CHIP Reauthorization Act). Clinicians can enroll in the program to initiate in the year of 2018. Those who participate might be qualified to earn the lump sum incentive payment for Medicare Part B payments under the advanced APM track starting in the 2018 performance year. The agency hopes an extra 70,000 physicians to qualify for incentive payments in the year of 2018 by adding this option as an advanced APM under MACRA.

2. The Track 1+ Model is a hybrid of Tracks 1 and 3 of the MSSP. It permits practices to initiate to take on little downside risk, but restricts exposure. The downside risk in Track 1+ is more restricted in contrast to Tracks 2 or 3.  

3. The program owns a 50% maximum shared savings amount. For view, Track 2 has a 60% MSR and Track 3 has a 75% MSR. Track 1+ has a fixed 30% loss sharing rate and the maximum level of downside risk will differ. The maximum loss limit will be capped at 8% of Medicare fee-for-service revenue or 4% of the updated historical benchmark, thus relying on the ACO composition. For ACOs, lower levels of risk might be offered with independent physicians or small rural hospitals.

4. The model follows that of MSSP Track 1 with some major differences. The main components of Track 3 involved in the new model are as follows:

• Option for symmetrical thresholds for shared savings and losses
• Prospective beneficiary assignment
• Option to utilize the 3-day skilled nursing facility waiver, permitting ACOs to admit sufferers to SNFs without a minimum 3-day inpatient hospital stay.

5. The application procedure will follow the similar timeline as all other MSSP applications. No application details have been finalized yet by CMS, but interested ACOs will require submitting a letter of intent in the month of May 2017. New ACOs and Track 1 ACOs will be eligible to apply. CMS plans to offer the model in the years of 2019 and 2020, in regard to 2018.