January 08, 2016
Area(s) of Interest: MACRA Practice Management
The legislation that repealed the Medicare sustainable growth rate—the Medicare Access and CHIP Reauthorization Act (MACRA)—created major new opportunities to advance alternative payment models (APM). Starting in 2019, MACRA will provide a 5 percent annual bonus payment to physicians who participate in APMs and it exempts them from participating in the fee-for-service meaningful use and quality reporting programs (MACRA's Merit-Based Incentive Payment System).
In addition to accountable care organizations, medical homes and bundled payments for hospital-based episodes, MACRA also provides for the development of “physician-focused” APMs. The American Medical Association (AMA) worked with Harold Miller at the Center for Healthcare Quality and Payment Reform to develop a “Guide to Physician-Focused Alternative Payment Models,” which describes seven different APMs that can help physicians in every specialty redesign the way they deliver care in order to improve patient care, manage health care spending and qualify for APM annual bonus payments. The seven APMs include:
- Payment for a High-Value Service
- Condition-Based Payment for Physician Services
- Multi-Physician Bundled Payment
- Physician-Facility Procedure Bundle
- Warrantied Payment for Physician Services
- Episode Payment for a Procedure
- Condition-Based Payment
The seven APMs described in the guide have been designed to be able to meet the MACRA eligibility criteria for APMs; however, this will require validation from the Centers for Medicare and Medicaid Services in the future rulemaking process. Under each APM, physicians would take accountability for specific aspects of spending and quality they can control or influence. Physicians will be required to accept some downside financial risk. However, unlike many APMs that have been implemented to date, the physician-focused APMs would not place physicians at financial risk for costs they cannot control.
Importantly, each of the APMs in this report would give participating physicians the resources and flexibility they need to redesign care systems so they can successfully improve care and manage spending for the particular patients, conditions and episodes for which they would be accountable.
In addition to describing the APM designs, the guide also provides examples of how the APMs are being used by different specialties and how they could be applied to diverse patient populations, including cancer care, cardiovascular care, chronic disease management, emergency medicine, gastroenterology, maternity care and surgery.
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Contact: Elizabeth McNeil, (800) 786-4262 or firstname.lastname@example.org.