Alternative Payment Models in Radiology: The Legislative and Regulatory Roadmap for Reform

Area of Science:

• Healthcare policy
• Medical economics
• Radiology reimbursement

Background:

• The Medicare Access and CHIP Reauthorization Act (MACRA) has been enacted.
• MACRA replaces the sustainable growth rate (SGR) payment system.
• It introduces the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentives.

Purpose of the Study:

• To inform radiologists about the key statutory requirements of MACRA.
• To explain the Merit-Based Incentive Payment System (MIPS) composite performance score and its payment implications.
• To highlight the implementation timeline and the definition of episode groups for radiologic services.

Main Methods:

• Review of the Medicare Access and CHIP Reauthorization Act (MACRA) legislation.
• Analysis of the Merit-Based Incentive Payment System (MIPS) framework.
• Examination of proposed regulations and commentary from organizations like the American College of Radiology (ACR).

Main Results:

• MACRA establishes a new payment framework for radiologists.
• The Merit-Based Incentive Payment System (MIPS) score directly impacts radiologist reimbursement.
• Episode groups, including those for radiology, are being defined under an aggressive timeline.

Conclusions:

• Radiologists must understand MACRA's requirements to adapt to new payment structures.
• Proactive engagement with MACRA initiatives is essential for radiology practices.
• The transition to MACRA necessitates a thorough understanding of performance metrics and payment adjustments.