Journal of Healthcare Management - May/June 2016 - (Page 176)

V A L U E - B A S E D C A R E Evolving Physician Reimbursement Structures: Moving the Medical Group to Value-Based Success Tawnya Bosko, DHA, vice president, Sg2, Skokie, Illinois, and Cami Hawkins, manager, GE Healthcare Camden Group, Austin, Texas N ow that the Medicare Sustainable Growth Rate (SGR) formula has been repealed, physicians and other providers must prepare for the Merit-Based Incentive Payment System (MIPS). We address several important questions about evolving physician reimbursement structures and provide guidance on how to succeed under the new programs. With passage of the Medicare Access and CHIP Reauthorization Act, what changes can physicians expect with regard to payment incentive models? Repeal of the Medicare SGR formula and passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) are bringing about significant changes to the Medicare physician fee schedule and reimbursement methodology (Centers for Medicare & Medicaid Services [CMS], 2015). MACRA established annual positive or flat fee updates for 10 years and implemented a two-track fee update thereafter. In addition, MACRA created MIPS and consolidated the current Medicare fee-for-service incentive initiatives. The law also provides a mechanism for physicians to participate in alternative payment methods, including the patient-centered medical home model and others to be defined. In repealing the SGR and passing MACRA, Congress's intent was to move away from the fee-for-service payment methodology and toward a value-based payment system. In preparation for changes to current fee-for-service incentive models, physicians and physician groups should be aware that 2016 is the last reporting period under the current Physician Quality Reporting System (PQRS) methodology. The 2016 reporting period will affect 2018 reimbursement, meaning that providers who do not meet reporting and participation requirements in 2016 will experience a 2% reduction in Medicare reimbursement in 2018 (CMS, 2016b). Satisfactory participation currently includes reporting on nine measures in three quality domains, as defined by CMS. Changes for 2016 include adding measures where gaps exist and eliminating measures that have topped out, are duplicative, or have been replaced by more robust measures. Legislative changes to the Electronic Health Record (EHR) Incentive Program are leading to a stricter definition of certified EHRs. These changes will align with the Office of the National Coordinator for Health Information Technology and govern 176

Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2016

VMSD - May 2016
Interview With Linda J. Knodel, FACHE, Senior Vice President and Chief Nursing Officer at Mercy
Five Ideas for the Development of Successful Physician Leaders
Evolving Physician Reimbursement Structures: Moving the Medical Group to Value-Based Success
Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations
Transformational Leadership and Change: How Leaders Influence Their Followers’ Motivation Through Organizational Justice
Succession Planning and Financial Performance: Does Competition Matter?
Transitions of Care in an Era of Healthcare Transformation

Journal of Healthcare Management - May/June 2016