Health Affairs June 15, 2017
Over the past two decades, Medicare has evolved into three separate programs or payment systems: fee-for-service (FFS), sometimes termed traditional Medicare; Medicare Advantage (MA); and the Medicare Shared Savings Program (MSSP), or accountable care organizations (ACOs). Regulations governing these three programs differ substantially. For example, participating plans, physicians, and other eligible clinicians are reimbursed and financially incented in different ways. Under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, FFS providers and some ACOs can earn an annual bonus that would increase their reimbursements by a certain percentage. Other ACOs can earn a percentage of shared savings and potentially an additional alternative payment model (APM) 5 percent bonus based on their previous year’s total Part B billing if...
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