Physician next by steven lash

Physician next by steven lash

• 1.
  Physician Payments Three elementsthat will shape Medicare physician payment over the next ten yens Steven Lash Managing Director Strategic Healthcare Advisory Services
• 2.
  New pressures, newresources  Pressure: The SGR replacement (MACRA) will impose 4-9% pay reductions on physicians who do not change  Resources: Practice Transformation Networks will provide regional assistance  Resources: Chronic Care Management (CCM) provides immediate cash flow for change
• 3.
  2026 and beyond 0.25%annual updates 0.75 annual updates 2019-2025 4-9% penalties/bonuses* 5% lump sum bonus 2015-2018 0.5% annual updates Merit-based Incentive Payments (MIPS) Alternative Payment Models (APMs) *Bonuses may be higher
• 4.
  What is MIPS? A fusion of the current incentive systems: Meaningful use, Physician Quality Reporting System (PQRS), and the Value-Based Modifier  In 2019: 4% penalty/4% bonus  Gradual increases for three years  By 2022: 9% penalty/9% bonus  Bonuses could be larger if scaling is applied
• 5.
  How to getout of MIPS  Meet minimum participation thresholds in APMs; either within Medicare caseload or across all payer caseload  APM participants who are close to but fall short of APM bonus requirements will not qualify for bonus but can report MIPS measures and receive incentives or can decline to participate in MIPS
• 6.
  What is anAPM?  Accountable Care Organization (ACO)  Innovation Center model, particularly bundled payment  Patient centered medical home  Other models to be specified by the Physician-Focused Payment Models Technical Advisory Committee (TAC).
• 7.
  Practice Transformation Networks  Cooperativeagreements for 29 organizations across the country  Each must enroll and engage a minimum number of physicians  GOAL: to prepare practices for alternative payment models
• 8.
  PTNs as resources Phase 1: Develop patient and family engagement tools  Phase 2: Expand care team, identify community partners, improve care transitions, continuity of care, patient self-management  Phase 3: Use EHR, use team roles and functions, care plans, use risk stratification, coordinate care  Phases 4,5: Create care coordination reports, establish links with practice as medical home, enable practice to take risk associated with episode management …but no cash assistance
• 9.
  CCM could providerevenue for transformation  Fee-for-service payment of $42 pm/pm  Aligns patients with your practices and system  Has foundational pieces for PCMH, managing episodes, and population health to succeed in an APM