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If ACOs had taken more risk in 2016, providers would have seen $966M more payments: 4 things to know

Medicare ACOs and participating physicians would benefit from assuming more financial risk under the new Medicare payment system, according to an Avalere report.

Here are four things to know:

1. Considering the current risk-based opportunities, Medicare ACO providers would have received $966 million in additional net payments if they had qualified for the 5 percent bonus payment available under the advanced alternative payment models in the Quality Payment Program. When ACOs assume downside risk, they can earn a lump-sum bonus equal to 5 percent of the Medicare Part B expenditures.

2. ACO participants have the opportunity to join the MSSP Track 1+ model, a hybrid model which gives providers the 5 percent bonus while limiting downside risk. This model became available in 2018.

3. The analysis from Avalere found among providers that participated in Track 1— the non-risk bearing track — around 91 percent would have received financial benefit from the risk-bearing models.

4. Of the ACOs that are repaying shared losses to CMS, around 75 percent would have seen the losses offset by AAPM bonuses if they had assumed risk.

"CMS is eager to encourage more ACOs to take on performance-based risk," said Avalere Director John Feore. "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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