MACRA and Alternative Payment Models

The Patient Protection Affordable Care Act created a number of new payment models that move away from paying health care providers for quantity of care (fee-for-service) towards quality of care they provide to patients. The ACR has developed resources to help our members understand and thrive in this new health care environment.

MACRA Resources

MACRA introduces quality payment programs in which physician payments will be based on participation in one of two pathways: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM), which reward physicians based on performance data and taking part in new payment and delivery models.

Access MACRA Resources »

How to Participate in the Quality Payment Program »

Accountable Care Organizations

ACOs are groups of doctors, hospitals and other health care providers who voluntarily come together to give coordinated, high-quality care to the patients they serve.

Watch: ACOs and Radiologists 

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Medicare Shared Savings Program

CMS released a proposed rule Dec. 1, 2014, that would make important changes to the Medicare Shared Savings Program (MSSP) for continued participation by ACOs and for Pioneer ACOs that are transitioning out of the Center for Medicare and Medicaid Innovation demonstrations.

The proposed rule would add a new two-sided risk model, called Track 3, which would involve prospective assignment of Medicare beneficiaries and higher shared savings and shared loss rates. It would also allow ACOs that participate in the one-sided, shared savings-only Track 1 to renew under the one-sided model for one additional, 3-year agreement period, but at a lower shared savings rate (rather than only having the option of applying for a two-sided risk model, including the existing Track 2).

CMS is also proposing to reduce the risk of incurring shared losses under Track 2 by using a minimum loss rate (MLR) that varies from 2 percent to 3.9 percent, based on the number of assigned beneficiaries (rather than the current 2 percent fixed MLR).

The proposed rule proposes other changes, as well, that would affect ACO eligibility requirements, beneficiary assignment to ACOs, data sharing, ACO participation agreements and other aspects of the program.

The proposed rule was published in the Dec. 8, 2014 issue of the Federal Register (79 FR 72760-72872) with a 60-day comment period ending on Feb. 6, 2015.

*Information courtesy of Alston+Bird LLP.

Bundled Payments for Care Improvement Initiative

Organizations in the Bundled Payments for Care Improvement demonstration enter into payment arrangements that include financial and performance accountability for episodes of care.

State Innovation Models Initiative

States participating in the SIM Initiative are prepared for or committed to planning, designing, testing and supporting evaluation of new payment and service delivery models in the context of larger health system transformation.

Articles on APMs

Additional Resources