The Impact of Changes in Medicare's Physician Payment System on Critical Care

Area of Science:

• Health Policy
• Medical Economics

Background:

• The Sustainable Growth Rate (SGR) mechanism for Medicare physician reimbursement has been repealed.
• The Medicare Access and CHIP Reauthorization Act (MACRA) mandates new payment models focusing on care quality over volume.

Purpose of the Study:

• To inform critical care stakeholders about the significant changes introduced by MACRA.
• To highlight the opportunity for the Society of Critical Care Medicine (SCCM) to influence new payment models for critical care.

Main Methods:

• Analysis of the legislative changes mandated by MACRA.
• Identification of the key components of the new Medicare physician payment framework.
• Assessment of SCCM's role in shaping critical care payment policies.

Main Results:

• MACRA replaces the SGR with a focus on value-based care.
• Physicians will transition to either the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs) starting in 2019.
• Existing quality reporting programs will be consolidated.

Conclusions:

• SCCM and its members have a critical opportunity to engage in developing new payment models for critical care.
• Proactive involvement is essential for ensuring that critical care services are appropriately valued under the new framework.