Commentary

Letter from the Editor: Value-based reimbursement is here to stay


 

 

For years, we advocated to repeal the sustainable growth rate (SGR) payment formula. Congress, by passing the MACRA legislation, eliminated SGR but created a new process that links provider reimbursement to value (quality and cost). Value-based reimbursement is here to stay. We now must help CMS devise reasonable linkages that will truly improve patient care, yet keep us in business. MACRA’s final rule is an improvement over the preliminary rule published earlier this spring. Gastroenterologists that plan to practice (and accept Medicare reimbursement) must educate themselves about both the incentive portion (MIPS) and alternative payment models.

Dr. John I. Allen
Proliferating rules about electronic health records, quality reporting, and care delivery will adversely affect independent practices and may drive some out of existence. CMS has heard about reporting burdens, so in the final rule (published at the end of October) they allowed more physicians to be exempt, reporting got easier, and we have a longer transition from fee for service.

MACRA intends to move independent practices into health systems (whether employed or contracted) that will assume financial and clinical risk. Gastroenterologists must lead clinical service lines for colon cancer prevention and integrated care for patients with IBD or cirrhosis. These care models must demonstrate good outcomes and substantive cost savings.

There are many sources of information about MACRA (see AGA resources at www.gastro.org/MACRA). I have listed four key websites:

https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf

 

http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_156.pdf

 

https://blog.cms.gov/2016/10/14/a-letter-from-cms-to-medicare-clinicians-in-the-quality-payment-program/

 

https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/

I hope you will take it to heart that we are moving into a new world of care delivery and payment. We need physician leaders and innovators to make sure this works well for our patients and our profession.

John I. Allen MD, MBA, AGAF
Editor in Chief

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