Physician-focused payment models provide an opportunity for radiologists to demonstrate and be rewarded for their contribution to patient care, and may encourage more radiologists to participate in advanced alternative payment models under the Medicare Access and CHIP Reauthorization Act of 2015, according to a new study by the Harvey L. Neiman Health Policy Institute.
The study is published in the Journal of the American College of Radiology.
"MACRA will look to increasingly shift physicians into APMs that incentivize quality and value," Andrew Rosenkrantz, MD, lead study author and a Neiman Institute affiliate research fellow, said in a news release. "PFPMs will provide a path for physician specialty societies to develop and propose new practice models that will allow a more diverse range of physician specialists to participate in alternative payment models."
MACRA, a landmark payment system for Medicare physician fees, was enacted in 2015 to replace the flawed sustainable growth rate.
The final rule for MACRA includes two pathways for provider participation: the Merit-Based Incentive Payment System, or MIPS, and the Advanced Alternative Payment Model. MIPS is designed for providers in traditional, fee-for-service Medicare. Advanced APM is designed for providers who are participating in specific value-based care models.
Participation in an advanced APM allows physicians, like radiologists, to earn a 5 percent lump sum incentive payment each year from 2019 through 2024 and avoid MIPS reporting requirements and payment adjustments. The final rule firms up details on what programs will qualify as advanced APMs. First, to qualify, advanced APMs must meet three requirements: Use certified EHR technology, base payments on quality measures comparable to MIPS and require providers to bear more than nominal risk. Beyond that, advanced APMs must also be an approved model by CMS.
According to the release, the study shows existing APMs meeting the criteria to be Advanced APMs are most relevant to primary care physicians, with relatively limited opportunity currently for radiologists to participate.
PFPMs, the release notes, are APMs that target the quality and cost of physician services and must address a new issue or specialty compared with existing APMs. PFPMs aim to encourage a much more diverse range of PFPMs that encompass a wider range of specialties, according to the release.
"As PFPMs provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, radiologists should embrace this new model and actively partner with other stakeholders, including health services researchers, in developing radiology-relevant PFPMs," Bibb Allen Jr., MD, chair of the Neiman Institute advisory board and past chair of the American College of Radiology Board of Chancellors, said in the release.