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Payment Models HealthcareTraditional incentive based payment models are being put phased out. The Centers for Medicare & Medicaid Services (CMS) is now pushing for alternative payment models that focus on quality of care rather than quantity.  The CMS hopes to tie 90% of all Medicare payments to alternative payment methods by 2018. To support this transition CMS has proposed changes to  the Medicare Access and CHIP Reauthorization Act (MACRA), which focuses on changing the way providers are reimbursed for care.

If your organization is using fee-for-service based payment models, now is a opportune time to learn about alternative payment models available. Unlike fee-for-service models,  alternative payment models hope to revolutionize the healthcare industry by tying quality and cost together. By doing this they can encourage providers to give the best possible care at the best possible cost.

More About MACRA…

Merit-Based Incentive Payment System (MIPS) 

MIPS focuses on combining the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one program. Eligible professionals for the new program will be measured on:

  • Cost
  • Quality
  • Clinical practice improvement activities
  • Advancing care information

Alternative Payment Model (APM) options

Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models all fall into the APM category. These new payment options are designed to change the ways healthcare providers are paid for Medicare services. The CMS defines APM options as “those in which clinicians accept risk for providing coordinated, high- quality care.”

General Requirements for APMs:

  • Bear a certain amount of financial risk (Total Risk, Marginal Risk, and Minimum Loss Rate)
  • Base payments on quality measures comparable to the ones used in the MIPS quality performance category
  • Participants must use certified EHR technology.

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