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Alternative Payment Models in Radiology: The Legislative and Regulatory Roadmap for Reform
Affiliation:1. South Texas Radiology Group, San Antonio, Texas;2. University of Texas Health Science Center at San Antonio, San Antonio, Texas;3. Weill Cornell Medicine, New York, New York;4. Harvey L. Neiman Health Policy Institute, Reston, Virginia;5. George Mason University, Fairfax, Virginia;6. Emory University School of Medicine, Atlanta, Georgia;1. Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California;2. American College of Radiology, Reston, Virginia;3. Albert Einstein College of Medicine and Department of Radiology, Neuroradiology Division, Montefiore Medical Center, New York, New York;4. Department of Radiology, Weill Cornell Medicine, New York, New York;5. Medical Education Division, American College of Physicians, Philadelphia, Pennsylvania;6. American College of Physicians, Philadelphia, Pennsylvania;1. Loyola University of Chicago, Chicago, Illinois;2. University of Chicago, Chicago, Illinois;3. Duke University Medical Center, Durham, North Carolina;4. Oregon Health and Science University, Portland, Oregon;5. Long Island Jewish Medical Center, New Hyde Park, New York;6. Allegheny General Hospital, Pittsburgh, Pennsylvania;7. Wake Forest University School of Medicine, Winston Salem, North Carolina;8. Virginia Mason Medical Center, Seattle, Washington, American Urological Association, Linthicum, Maryland;9. Brigham & Women’s Hospital, Boston, Massachusetts;10. Medical College of Wisconsin, Milwaukee, Wisconsin;11. University of Cincinnati Medical Center, Cincinnati, Ohio;12. University of Washington, Seattle Cancer Care Alliance, Seattle, Washington;13. Cleveland Clinic, Cleveland, Ohio;14. University of New Mexico, Albuquerque, New Mexico
Abstract:The Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on the Merit-Based Incentive Payment System and incentives for alternative payment model participation. It is important that radiologists understand the statutory requirements of MACRA. This includes the nature of the Merit-Based Incentive Payment System composite performance score and its impact on payments. The timeline for MACRA implementation is fairly aggressive and includes a robust effort to define episode groups, which include radiologic services. A number of organizations, including the ACR, are commenting on the structure of MACRA-directed initiatives.
Keywords:Medicare Access and CHIP Reauthorization Act (MACRA)  Merit-Based Incentive Payment System (MIPS)  alternative payment models (APMs)  Physician Quality Reporting System (PQRS)  episode groups  Center for Medicare and Medicaid Innovation (CMMI)  Health Care Payment and Action Network (HCPLAN)  resource use  clinical practice quality improvement activities
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