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Alternative payment models and urology
Deborah R Kaye1, David C Miller, Chad Ellimoottil
1aInstitute for Healthcare Policy and Innovation, University of Michigan bDow Division of Health Services Research, Department of Urology, Ann Arbor, Michigan, USA.
Purpose Of Review:
The Medicare Access and CHIP Reauthorization Act (MACRA) is a historic bill that was recently passed that establishes how quality measurement and practice patterns will affect physician reimbursement. Alternative payment models (APMs) are an essential component of MACRA and Medicare's vision of paying for high-value care. This review describes APMs in the context of MACRA and their impact on urology.
Recent Findings:
The majority of urologists will be affected by MACRA. Both APMs and bundled payments are considered APMs under MACRA. Although most urologists do not currently participate in Accountable Care Organizations (ACOs) and Bundled Payments, both models are considered APMs under MACRA and are likely going to gain increasing attention in the coming years.
Summary:
APMs will likely become more relevant to urologists' practices in the future, as both the Centers for Medicare and Medicaid Services and private payers are transitioning away from fee-for-service towards value-based payment.
Insights
The Medicare Access and CHIP Reauthorization Act (MACRA) impacts physician pay. Alternative Payment Models (APMs) are key to MACRA, influencing urology practices and shifting towards value-based care.
Area of Science:
- Health Policy
- Medical Economics
- Urology Practice Management
Background:
- The Medicare Access and CHIP Reauthorization Act (MACRA) fundamentally alters physician reimbursement.
- Alternative Payment Models (APMs) are central to MACRA's objective of promoting high-value healthcare.
- Understanding APMs is crucial for navigating the evolving landscape of medical practice.
Purpose of the Study:
- To review Alternative Payment Models (APMs) within the framework of MACRA.
- To analyze the specific impact of APMs on the field of urology.
- To provide insights into the future of physician reimbursement in urology.
Main Methods:
- Literature review of MACRA legislation and related healthcare policy documents.
- Analysis of current and projected physician participation in APMs.
- Examination of the transition from fee-for-service to value-based payment models.
Main Results:
- The majority of urologists will be affected by MACRA's reimbursement changes.
- Accountable Care Organizations (ACOs) and Bundled Payments are key APMs under MACRA.
- While current participation in ACOs and Bundled Payments is low among urologists, their significance is expected to grow.
Conclusions:
- APMs are increasingly relevant for urologists as healthcare payment models evolve.
- The Centers for Medicare and Medicaid Services (CMS) and private payers are shifting from fee-for-service to value-based care.
- Urologists should prepare for greater integration of APMs into their practice and reimbursement structures.
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