MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology

Area of Science:

• Health Policy
• Medical Economics
• Radiology

Background:

• The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 promotes alternative payment models (APMs) to incentivize value-based care.
• Advanced APMs offer significant financial incentives for qualifying participants.
• Current APM opportunities are limited for radiologists, primarily benefiting primary care physicians.

Purpose of the Study:

• To explore the potential of Physician-Focused Payment Models (PFPMs) as a pathway for radiologist participation and reward within MACRA.
• To highlight the need for radiologists to engage in the development of PFPMs relevant to their specialty.

Main Methods:

• Analysis of MACRA legislation and its implications for physician payment models.
• Examination of the structure and function of the Physician-Focused Payment Models (PFPMs) and the PFPM Technical Advisory Committee.
• Assessment of current APM landscape and opportunities for specialist involvement.

Main Results:

• PFPMs are designed to introduce new APMs targeting specific physician services, fostering specialty diversity.
• The PFPM Technical Advisory Committee reviews proposals but does not mandate consultation with clinical experts for specialist-proposed PFPMs.
• Radiologists have limited direct opportunities in current Advanced APMs but PFPMs offer a new avenue.

Conclusions:

• Physician-Focused Payment Models (PFPMs) present a significant opportunity for radiologists to demonstrate value and receive appropriate reimbursement.
• Radiologists should proactively engage with stakeholders to develop and advocate for PFPMs tailored to radiology's unique contributions to patient care.