Value-based care and alternative payment models: Will you take the plunge?

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.

 

Is that enough motivation to compel resource-strapped physicians to jump to an APM? Time will tell -- and it may tell soon, now that we know MACRA reporting begins next year. In the meantime, you may be interested in an instructive article in Health Affairs, Brave New World: Medicare's Advanced Payment Models, which talks APMs in detail.

 

You can also gain an early glimpse of what APMs figure to look like in a story that appeared in the February 1 issue of Part B News.