The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the new physician payment law that replaces the SGR formula, cuts Medicare spending, and extends CHIP. MACRA moves Medicare from a fee-for-service system to one that pays for the quality of care.
In 2019, all physicians will be required to select between two different pathways; Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).
The American Osteopathic Association (AOA) has put together a description on MACRA and the two payment pathways. Below is a general description of each pathway and inventive system. All physicians are encourage to click here for further details regarding MIPS, APMs and payment incentives.
Click here to download the 2015 MACRA Facts Brochure.
MIPS streamlines CMS reporting programs into one scoring physicians in four categories:
EHR Meaningful Use (25%)
Quality PQRS (30%)
Value-based modifier/resources (30%)
Clinical Improvement Activities (15%)
Physician payment will be based on a physician’s composite performance score that will be compared to a threshold based on the average performance of all physicians in the program.
APMs must use certified EHR technology and bear financial risk for losses OR be a PCMH. A qualifying APM could be an Accountable Care Organization, Patient-Centered Medical Home, Bundled Payment Initiatives, or others to be developed. Involvement in APMs exempts providers from MIPS.
Physicians will receive positive payment incentives via annual updates for five years:
July 2015-2019: .5% update period of stability
2019-2024: MIPS Incentives, or 5% APM bonus
2026 and beyond: .75% update in APM or .25% update in FFS
Access to Care
Access to health care means having “the timely use of personal health services to achieve the best health outcome.”
Attaining good access to care requires three steps:
1) Gaining entry into the health care system.
2) Getting access to sites of care where patients can receive needed services.
3) Finding providers who meet the needs of individual patients and with whom patients can develop a relationship based on mutual communication and trust.
Emergency medicine is and always has been the safety net of the nation’s health care system, caring for everyone, regardless of ability to pay. Inadequate coverage of the uninsured, cutbacks in Medicare, declining payments by health plans, and a medical liability crisis threaten the ability of emergency physicians to continue to provide high-quality care to everyone. Emergency visits have increased at twice the rate of the U.S. population, and they will continue to increase. It is the goal of the Governmental affairs committee of the ACOEP to advocate for access to care for our patients.
We advocate for access to the appropriate care at the appropriate time.
Physician Safety and Wellness
ACOEP is adamant in regards to our physicians’ safety and well-being.
Physician well-being is a national focus. Physicians take an oath to do no harm, but this is often not applied to their own personal wellness. This goes far beyond just eating healthy and exercising more. The challenges of medicine and in particular emergency medicine place a great deal of stress on our physical and emotional well-being.
Violence is a public health problem of epidemic proportions. The danger to health care providers in professional settings escalates as violence moves off the streets and into the medical setting. Violence an inescapable part of our lives, however optimal patient care is achieved only when patients, visitors, and health-care workers are protected against violent acts occurring within the health-care setting. A safe working environment is conducive to improved staff morale, and enhanced productivity.
It is the mission and goal of the Governmental Affairs committee of the American College of Osteopathic Emergency Physicians to educate and advocate for our physicians to maintain a personal well-being and safety in the workplace.
The Emergency Medical Treatment and Active Labor Act (EMTALA) is a statute which governs when and how a patient may be refused treatment or transferred from one hospital to another when he or she is in an unstable medical condition. EMTALA only applies to participating hospitals, which is defined as hospitals that have entered into “provider agreements” under which they will accept payment from the Department of Health and Human Services and Medicare and Medicaid Services.
The Governmental Affairs Committee will continue to monitor the provisions, requirements, and penalties regarding EMTALA.