Fee-for-Value Cardiovascular Contracting

Payment Initiatives
 

MACRA is here: a flexible system that reforms Medicare payment by linking quality and payment: Merit-Based Incentive Payment Systems (MIPS) and Advanced Alternative Payment Models (APM).

  CFA can assist physicians to develop comprehensive responses to these new regulations that will have a serious impact on both practice revenue and expense.

   

Strategy
 
 
Service Delivery
 
 
Revenue Growth

 

The Challenge of MACRA and Physician Payment Reform

Today’s cardiovascular medical groups must deal with a continual barrage of reimbursement and regulatory changes.  At risk contracts,  ICD-10, fee for value and the newly announced cardiac bundling initiative for hospitals, which is set to begin in selected metropolitan service areas (MSA) in 2017, are but a few examples.

The Medicare Access and CHIP Reauthorization Act (MACRA) presents the single largest and most sweeping physician payment reform measure to date.  MACRA transitions professional fee reimbursement from a standard, prospective fee schedule format year over year to a “fee for value” model of reimbursement where quality outcomes and compliance rates for required practices (such as use of EHR) are used to determine physician reimbursement levels.

It is estimated that Medicare revenue for medical practices could decrease up to 4% in the first year if medical groups do not meet their base quality outcome(s) requirements, and resource use, clinical practice improvement and certified electronic health record (EHR) compliance targets.

Here is a brief overview of what all CMS provider medical group organizations will be facing with MACRA:

Merit-Based and At Risk Incentive Payment Systems (MIPS vs. APM)

  1. Physicians will be required to assume reimbursement risk based on meeting certain performance outcomes (risk/incentive options are determined via a sliding risk/reward scale from minimum to maximum). The more risk the higher payment for meeting/exceeding quality and operational goals. This is know as the Merit-Based Incentive Payment System (MIP’s).

A second option Alternative-based Payment Models ( APM’s) offer much higher financial rewards but require assuming an almost full risk payment arrangement with CMS. Participation in this option requires medical groups to be proficient in delivering risk/capitation based services using newer, more sophisticated software tracking systems.

  1. Selection of a payment option (MIP’s or APM’s) are to be phased-in starting in late 2017.
  2. Those who choose the MIPS option will must follow CMS reporting requirements to receive incentive reimbursement payments.

CFA’s Solutions

CFA provides cardiovascular group practices with the following menu of MACRA-based physician reimbursement tools and consulting support and technical assistance to successfully navigate the new payment reform challenges cardiovascular physicians are facing:

  • Practice-readiness assessment
  • Optimization of practice IT capabilities
  • Best practice methodology/templates to decrease cost and improve quality outcomes
  • Coding and billing support
  • CMS reporting requirements assistance

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