With Medicare’s new physician payment system having launched this year, health systems are initiating multiyear efforts to push many of their employed and affiliated physicians into advanced alternative payment models (APMs).
Although the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) determines only Medicare Part B payment, hospitals and health systems will be affected through their employed and affiliated physicians. So those organizations are working to help their physicians succeed under the payment system, which will mean moving as quickly as possible to advanced APMs.
Initially, 90 percent of physicians are expected to not meet the criteria for qualifying APM participation and instead to default into the Merit-based Incentive Payment System (MIPS), which will expose them to potential penalties of as much as 9 percent of their Medicare pay in coming years.
Kavita Patel, MD, a former White House healthcare advisor, said most clinicians and C-suite leaders “have no idea how they are performing on even internal benchmarks, much less national benchmarks—[because] they need to focus on today.”
Entities that have experience with MSSP ACOs have some data that can give insights on patterns of care, “but many don’t seem to be using that,” Patel said.
Patel said hospital and practice leaders need to push leadership teams and clinical teams to tell them how far along their organization is in the transition to value-based payments.