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