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VBCR - June 2015, Volume 4, No 3 - Value Propositions

As the era of the Medicare Access and CHIP Reauthorization Act (MACRA) begins, physicians must think about choosing 1 of 2 reimbursement systems that will go into effect in 2019: the Merit-Based Incentive Payment System (MIPS) or an alternative payment model (APM). Robert B. Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians (ACP), discussed MACRA at a recent media briefing.

Doherty explained that under MACRA reimbursement is stabilized and time is allowed for the transition to “value-based” payments. The program will provide annual baseline Medicare payment increases of 0.5% from July 1, 2015, through December 31, 2018. Beginning in 2019, and annually thereafter, physicians will have to participate in the MIPS program or choose an APM. Although switching from one program to the other will be permitted each year, the differences in requirements would necessitate changes in practice management.

Of the 2 programs, the MIPS is closer to a fee-for-service model. However, reimbursement will be adjusted annually based on performance in 4 categories: clinical quality, meaningful use of health information technology, resource use, and practice improvement. Failure to meet new performance measures will result in a payment decrease. Physicians who prefer the opportunity to earn more may choose an APM and practice within an accountable care organization or advanced patient-centered medical home. There is, however, greater financial risk involved in the APM model.

Nitin Damle, MD, incoming ACP president, advised physicians to begin preparing now for MACRA requirements. He said, “You really need to have electronic medical records,…team-based care, and…an office that has an efficient work flow. Otherwise, it will be very difficult…to report some of these measures…required…to get some of these payment incentives.” McKnight W. Rheumatology News Digital Network. May 1, 2015.

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Last modified: June 29, 2015
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