Physician Next by Steven lash

1
Physician Payments

• Three elements that will shape Medicare physician
  payment over the next ten yens

Steven Lash Managing Director Strategic
Healthcare Advisory Services
2
New pressures, new resources

• 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
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 get out 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 an APM?

• 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

• Cooperative agreements 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 provide revenue 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