BUSINESS CONSULT
FIGURE 2
Alternative Payment Models (APMS)
0.5%
0.0%
0.75%
Annual Update
Annual Update
Annual Update APMs
2015–2019
2020–2025
5%
2026 and beyond
Annual Bonus for Participation
2019–2024
Medicare
25% Revenue
Requirement
2019–2020
1. Aged Data for Incentive Compensation
Programs similar to MIPS indicate there could
be significant delays between actual provider
performance and receipt of MIPS payment. Additionally, performance under MIPS is identified
at the provider level (tax identification number),
not the individual physician level (National
Provider Identifier), meaning providers can be
rewarded or penalized for the performance of
physicians who no longer work at their practice.
2. Complex Incentives
Based on the variation of existing PQRS measu res (281 potential metrics) and the plethora of
physician specialties, MIPS will almost certainly
involve a complex incentive reporting formula,
creating considerable uncertainty regarding
physician reimbursement.
3. Physician Influence Over Incentive Measures
Resource utilization measures may take into
account metrics that are outside the control of
individual physicians. Conversely, a focus on metrics for which physicians have direct control may
result in changes to referral patterns, decreasing
compensation for physicians who are unable to
meet the new cost containment goals of certain
providers (e.g., specialists who order an inordinate number of cardiac catheterizations).
MACRA also presents significant implications for
the relationships between physicians and hospitals.
Both the MIPS and APM payment tracks will require that providers establish substantial resources
and infrastructure in order to develop the systems
and capacity to manage cost and demonstrate quality. Intensifying financial pressures will be experienced most by independent physicians. As a result,
recent trends of increasing physician integration
46 CardioSource WorldNews
Medicare
Medicare
50% Revenue
75% Revenue
Requirement
2021–2022
Requirement
2023 and beyond
It’s critical for
providers to
understand the
implications of
MACRA in order to
prepare for the future
challenges this act
will entail.
Reference:
Letter dated Nov. 17, 2015, from James Madara, MD,
Executive Vice President and CEO of the AMA, to Andrew Slavitt,
Acting Administrator of CMS.
Amol S. Navathe, MD, PhD, is a physician at Brigham
and Women’s Hospital, a clinical fellow at Harvard
Medical School, and adjunct faculty member at the
Leonard Davis Institute of Health Economics of the
Wharton School of Business, University of Pennsylvania.
Dr. Navathe is also the co-Editor-in-Chief of Health Care:
The Journal of Delivery Science and Innovation.
3 Ways
to read the news magazines
of the American College
of Cardiology:
(e.g., employment, PSAs) and practice consolidation
will likely continue as provider organizations seek
to build the scale necessary to control spending
under APMs.
Start Planning for MACRA Now
While MACRA continues to evolve, providers
should be mindful of the adjustments to the Medicare payment system and the effect on the role of
physicians in healthcare delivery. MACRA is bringing significant changes that will be experienced by
many, regardless of whether you are on the provider or physician side. There’s a lot that organizations and physicians need to do in order to properly
position themselves for payment reform—because
although the full impact of MACRA may not be felt
for years, the time to prepare is now.
For more information about MACRA contact
Dave Wofford at [email protected]. ■
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April 2016