Feds Propose Rules for How Medicare Pays Physicians

Federal regulators proposed a rule Wednesday that will adjust hundreds of thousands of physicians’ Medicare payments to reward or penalize them based on how healthy they keep their patients. (USA Today)

One rule implements what is called the Quality Payment Program, which gives doctors two options for getting reimbursed under Medicare: they can participate either in the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). (MedPage)

MIPS pays for providing high value care through success in four categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost.(Healthcare Finance)

The APM path will reflect traditional Medicare payments in the first two years and then will be opened to all payers, including Medicare Advantage plans, said Dr. Patrick Conway, the CMS’ chief medical officer. (Modern Healthcare)

It uses paths that have already put in motion by the Affordable Care Act, such as Accountable Care Organizations, where groups of doctors come together to share in Medicare’s savings if they reduce costs and meet quality goals.(The Hill)


What are Accountable Care Organizations?