As physician practices grapple with Medicare's onerous
quality-reporting programs, worry about
ICD-10 implementation and, you know, perform that small task known as caring for their patients, a significant question looms on the horizon: Will they step into the value-based world of alternative payment models (APM)?
While many practices have moved to value-based payment and delivery mechanisms, most notably in the form of
patient-centered medical homes (PCMHs) and accountable care organizations (ACOs), APMs are on pace to become a cornerstone of Medicare reimbursement in a way that the industry has not yet seen.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 solidified the importance of APMs in a significant way. One selling point is that practices that transition to an APM-type of delivery model will gain 5% in Medicare reimbursement starting in 2019 -- contrasted to a flat rate for providers that continue to operate in the fee-for-service realm.
Secondly, providers that turn to an APM model will be automatically freed from participating in the
merit-based incentive payment system (MIPS), a combination of the big three quality-reporting programs (meaningful use, PQRS and the value-based modifier) that have vexed providers for years.