To succeed in the proposed Medicare Shared Savings Program, the smallest accountable care organizations will have to save 3.9 percent above the savings benchmark and, on a sliding scale, the largest ACOs will have to save 2 percent above the benchmark.

But 2 percent was the threshold to meet in similar programs the government piloted in recent years and it was tough to meet, recalls Chet Speed, vice president of public policy at the American Medical Group Association, which represents specialty or multi-specialty practices. "Many sites felt that was a significant obstacle to shared savings." Consequently, 3.9% under the new proposed program would be "very difficult" to achieve, he adds.

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