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New Medicare Physician Payment System: Physicians will have 'more choice and control' over how they are paid yet successful implementation is a 'tall order'

Article by ACP's Bob Doherty explains what comes next… and its challenges

(Washington, May 12, 2015)- "After years of haunting physicians with the specter of scheduled Medicare payment cuts, the Sustainable Growth Rate (SGR) formula was put to rest on April 16 when President Obama signed the Medicare Access and Children's Health Insurance Program Reauthorization Act (MACRA)," Bob Doherty, senior vice president of the Division of Governmental Affairs and Public Policy of the American College of Physicians (ACP), said today. "In addition to repealing the formula, this act promises to transform Medicare physician payments from a system that rewards volume to one that recognizes value."

Doherty's comments came in an article that was published online first today in the Annals of Internal Medicine.

"The MACRA," Doherty said, "is about more than SGR repeal: It's also about accelerating changes in Medicare payment policies to recognize value rather than volume. It offers physicians more stability and potentially more control over reimbursement in the following ways:

  • Payments are stabilized. The MACRA provides physicians with baseline annual Medicare payment updates of 0.5 percent from July 1 this year through December 31, 2018, allowing time for transition to 'value-based' payments.
  • Physicians have more choice and control over how they are paid. Beginning in 2019, annual updates on physician payments will be based on a physician's successful participation in a new quality reporting program called the Merit-Based Incentive Payment System (MIPS) or in an alternative payment model (APM). Physicians, or their practices, will decide annually in which they wish to participate."

In his article, Doherty provides details on the MIPS and APM programs and their implementations. He concludes by noting that, "Now that the SGR is gone, physicians must advocate to ensure that the MIPS and APMs measure the right things, do not add to administrative burdens or undermine professionalism, offer true choice, and improve the quality of care-a tall order."

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 141,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

Contact: David Kinsman, (202) 261-4554, dkinsman@acponline.org