The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) perpetually removes sustainable growth rate (SGR). MACRA also eliminates SGR’s annual threat of physician payment cuts. The American Medical Association provides physicians with vital tools to be successful through this long-term transition period.
Two options of physician payment currently exist. They are the Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). APMs is a method that MACRA has implemented to support physicians who would like to utilize new payment and delivery models approved by the Centers for Medicare & Medicaid Services. Involvement in these new models is considered voluntary. Physicians who choose to be paid under eligible APMs are excused from partaking in MIPS. MIPS is considered to be a modified fee for service model and combines previous reporting programs (Physician Quality Reporting System, Value-Based Modifier, Meaningful Use) to allow for greater flexibility. Lastly, it is assumed the most physicians will be participants in MIPS initially.
Before you determine what type payment methods you would like to implement in your practice, let’s consider the benefits and disadvantages of each payment option.
APMs
Advantages
Yearly bonus: Physicians will be provided a 5% annual lump sum payment to physicians who participate in qualified APMs at specified threshold levels, and it excuses them from the new MIPS.
Recover MIPS score: Physicians in other APMs than previously mentioned or participation in qualified APMs at levels below at levels below the MACRA thresholds have the opportunity to improve their MIPS scores.
Improve Care and Reduce Spending: In terms of clinical services, the search for improved quality care with a lower out of pocket price tag is endless. Some ways physicians are able to do this trough APMs include reducing the risk of heart attacks in patients with stable angina and improving diagnostic accuracy, treatment planning and medication adherence in patients with asthma.
Disadvantages
Electronic medical records: Participating in an APMs requires the physicians use electronic medical records which implies changing their entire system in terms of medical record management increasing costs of program purchases and training.
Adjustment period: There will a be a time that physicians and patients will need to undergo an adjustment period until the new payment changes are in place and stable which can be stressful on both sides. Medical Billing Services might have more experience helping physicians as they have more expertise.
MIPS
Advantages
Reduce financial penalties: Consolidating the current systems in place reduces the collective amount of financial penalties for physicians. Potential bonus payments are also possible.
Enhances current Medicare programs: Physicians can enhance the care of Medicare programs by providing expanded practice access, better care coordination, and patient engagement.
Familiar system: Since MIPS is a consolidation of all the programs already in use, the overall transition from their current system to MIPS is not as difficult as APMs.
Disadvantages
Adjustment period: Similar to that of APMs, there will a be a time that physicians and patients will need to undergo an adjustment period until the new payment changes are in place and stable which can be stressful on both sides.
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