The new law takes concerted steps to incentivize and encourage providers to develop and participate in APMs (Alternative Payment Models). As with the CPIA discussed above, the details of APMs are not yet fully clear and are currently being developed. ACS is actively working on behalf of surgeons to develop APMs as part of the policy efforts of the Division of Advocacy and Health Policy. In general, these programs will require quality measures, the inclusion of elements of upside and downside financial risk for providers and use of certified electronic health record technology. For those surgeons who receive a significant share of their revenue from an APM, an annual 5% bonus will be available for each of the years 2019-2024. To qualify for that bonus, surgeons must receive 25% of their Medicare revenue from an APM in the years 2019 and 2020. That threshold requirement subsequently increases to 50% in 2021 and ultimately to 75% beginning in 2023.
As MACRA specifies that providers participate in either MIPS or APMs, surgeons who meet the aforementioned threshold of payment from a qualified APM will be exempted from many of the MIPS reporting requirements and receive the 5% bonus in lieu of the previously described MIPS payment adjustment. Those who participate in APMs but fail to meet the threshold necessary to receive the 5% bonus will receive credit for their participation in the CPIA component of their MIPS composite score but will not receive the 5% incentive.
While it is completely understandable that acronyms add to surgeons’ collective frustration, I am confident that all Fellows can, with relative ease, master the seven acronyms above and thus be well on their way to both understanding and successfully participating in the new Medicare physician payment system.
Until next month …
Dr. Patrick V. Bailey is an ACS Fellow, a pediatric surgeon, and Medical Director, Advocacy, for the Division of Advocacy and Health Policy, in the ACS offices in Washington, D.C.