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Medicare Providers Mull Pay-for-Performance Options
A number of health care providers are deciding whether to join an accountable care organization (ACO) or to be part of Medicare’s Merit-Based Incentive Payment System (MPIS), Healthcare IT News recently reported.
Included in the 2015 Medicare Access and CHIP Reauthorization Act, MPIS is set to begin next year; 2017. In the meantime, providers are anticipating rules, which should be finalized by November 2016 and could come as early as spring 2017, the article reported.
"People are waiting with bated breath for MIPS rules, just like they were for meaningful use," said Tom Lee, CEO and founder, SA Ignite, which develops analytics tools to help providers manage value-based programs, in the article. "The biggest thing on the horizon is there are a lot of details on this that will come to light when the rules come out."
The Medicare Part B Sustainable Growth Rate reimbursement formula was repealed in the Medicare Access & CHIP Reauthorization Act of 2015 and replaced with a performance-based payment model. Providers have the option to join an ACO or be placed in MPIS.
“When choosing a program, providers must assess the risk and whether they want the guaranteed 5 percent from ACOs or choose MPIS, where the value-based swing between the lowest and highest reimbursement could be up to 36% when accounting for bonuses,” Healthcare IT News reported.
“MIPS has higher bonuses, but higher risks," Lee told the publication."Providers don't need to choose a physician group to be a part of the program, but those providers who don't remain on top of the heap lose money.”—Jolynn Tumolo
