CardioSource WorldNews - Page 48

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 dwofford@ecgmc.com. ■ Print iPad Online April 2016