Now that the Sustainable Growth Rate (SGR) is no more, practices must choose one of two paths for reimbursement going forward. Beginning in 2019, physicians will be paid either according to a merit-based incentive payment system (MIPS) or through an alternative payment model (APM), explained Robert B. Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians (ACP), at a media briefing.
Although physicians will be allowed to switch between models from one year to another, the time to select their initial approach and put the appropriate infrastructure into place is now, according to Family Practice News.
Out of the two options, MIPS is closer to fee-for-service, but it also allows the Centers for Medicare & Medicaid Services (CMS) to incrementally adjust its fees based on scores in clinical quality, meaningful use of electronic health records, efficiency and practice improvement. Under the model, physicians will be compared either to their peers in the same specialty or to themselves to determine how they have maximized resources from year to year. In 2019, the range of positive or negative payment adjustments in the MIPS program is minus 3.5 percent to plus 4.5 percent, and gradually increase until it settles at plus or minus 9 percent in 2022.
APM, on the other hand, offers the highest possible reimbursement--a guaranteed 5 percent annual payment increase from CMS over the first 6 years of the program, within the construct of an accountable care organization (ACO) of the practice's choice. What's more, if a practice is a certified patient-centered medical home, "right away you are guaranteed the highest possible clinical improvement score," which represents 15 percent of the total value score, noted an article from MedPage Today.
However, the risks are also greater with the APM model, noted FPN, because physicians who do not meet the metrics stipulated by their ACO will not be rewarded with their shared savings on top of their CMS updates.
The ACP is developing a software tool that will help physicians determine the best payment method for their practice, according to MedPage.