MACRA and the future of value-based care

Jones, Lyell K.; Raphaelson, Marc; Becker, Amanda; Kaloides, Amy; Scharf, Eugene

doi:10.1212/cpj.0000000000000296

Cited by 15 publications

(11 citation statements)

References 4 publications

(4 reference statements)

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“…Moreover, new changes in reimbursement models are being implemented, reflected in the MACRA bill which outlines the transition of some Medicare payments to a value-based model incorporating quality as a metric for reimbursement. 16 Although encouraging high-value care is worthwhile, Swartz and Cheng 17 raise concerns that surgeons may defer high-risk and complex patients to increase their quality ratings. The effects of MACRA on neurosurgery are not yet clear, and its impact will require continued review over the coming years.…”

Section: Discussionmentioning

confidence: 99%

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

et al. 2023

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BACKGROUND:An estimated 50 million Americans receive Medicare health care coverage. Prior studies have established a downward trend in Medicare reimbursement for commonly billed surgical procedures, but it is unclear whether these trends hold true across all neurosurgical procedures.OBJECTIVE:To assess trends in utilization, charges, and reimbursement by Medicare for neurosurgical procedures after passage of the Affordable Care Act in 2010.METHODS:We review yearly Physician/Supplier Procedure Summary datasets from the Centers for Medicare and Medicaid Services for all procedures billed by neurosurgeons to Medicare Part B between 2011 and 2019. Procedural coding was categorized into cranial, spine, vascular, peripheral nerve, and radiosurgery cases. Weighted averages for charges and reimbursements adjusted for inflation were calculated. The ratio of the weighted mean reimbursement to weighted mean charge was calculated as the reimbursement-to-charge ratio, representing the proportion of charges reimbursed by Medicare.RESULTS:Overall enrollment-adjusted utilization decreased by 12.1%. Utilization decreased by 24.0% in the inpatient setting but increased by 639% at ambulatory surgery centers and 80.2% in the outpatient setting. Inflation-adjusted, weighted mean charges decreased by 4.0% while reimbursement decreased by 4.6%. Procedure groups that saw increases in reimbursement included cervical spine surgery, cranial functional and epilepsy procedures, cranial pain procedures, and endovascular procedures. Ambulatory surgery centers saw the greatest increase in charges and reimbursements.CONCLUSION:Although overall reimbursement declined across the study period, substantial differences emerged across procedural categories. We further find a notable shift in utilization and reimbursement for neurosurgical procedures done in non-inpatient care settings.

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Section: Discussionmentioning

confidence: 99%

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

et al. 2023

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“…MACRA requires most Medicare providers to choose 1 of 2 pathways for reimbursement: the Merit-Based Incentive Payment System (MIPS) or one of several Advanced Alternative Payment Models (AAPMs). 22 Especially in the early years of the program, most physicians (including neurologists) will participate in the MIPS pathway, which will continue to provide payment to physicians based on existing fee-for-service architecture. Therefore, the services and codes outlined in this article will remain a relevant consideration for most physicians participating in Medicare.…”

Section: G0509mentioning

confidence: 99%

Expanding incentives for coordinated, patient-centered care

et al. 2018

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Historically, payment for cognitive, nonprocedural care has required provision of face-to-face evaluation and management as part of general ambulatory or inpatient care. Although non-face-to-face patient care (e.g., care via electronic means or telephone) is commonly performed and is integral to patient-centered care, appropriate reimbursement for this type of care is lacking. Beginning in 2017, Centers for Medicare and Medicaid (CMS) has taken a large step forward in reimbursing an increased number of cognitive care and non-face-to-face codes. CMS has also included language indicating that nonphysician providers (i.e., nurse practitioners and physician assistants) can perform many of these services independently. The 2017 and now the 2018 fee schedules thus create new payments for non-face-to-face, patient-centered services, and may allow neurologists to reach out to more patients through nonphysician providers. As health care in the United States moves toward value-based incentives, these newly supported non-face-to-face services will provide neurologists with new tools to deliver sustainable, high-value care.

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“…Beginning in 2017, most physicians who participate in Medicare will do so in 1 of 2 pathways, the Merit‐Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (AAPM) track (see Fig. , Supporting Information Glossary of Terms).…”

Section: Macra and The Qppmentioning

confidence: 99%

“…Again, by example, a neuromuscular neurologist in an independent practice may not have access to an ACO, or his local ACOs may require untenable terms of participation. MACRA required the creation of the expansively named Physician‐Focused Payment Model Technical Advisory Committee, which is charged with reviewing and recommending specialty‐relevant AAPMs to CMS …”

Section: Macra Specialties and Subspecialtiesmentioning

confidence: 99%

“…CMS has made some allowances for physicians in small groups, for example, by excluding small practice providers from a MIPS penalty for excess hospital readmissions and easing the scoring for the IA portion of MIPS. MACRA acknowledges that it is essential to support small practices and has allocated $100 million over 5 years to address the needs of these providers, although it is unclear how these resources will be deployed.…”

Section: Impact On Small Practicesmentioning

confidence: 99%

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The value transformation of health care: Impact on neuromuscular and electrodiagnostic medicine

2017

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Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. Here we review emerging trends in development of value-based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value-based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists.Muscle Nerve 56: 679-683, 2017 SGR, sustainable growth rate; VBPM, value-based payment modifier

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MACRA and the future of value-based care

Cited by 15 publications

References 4 publications

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019

Expanding incentives for coordinated, patient-centered care

The value transformation of health care: Impact on neuromuscular and electrodiagnostic medicine

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