Steven lash
Physician Payment in the Post-SGR Era • Legislation called the Medicare Access and CHIP Reauthorization Act (MACRA) passed earlier this year (2015) has already made fundamental changes to the way physicians are reimbursed by Medicare and will continue to reshape physician reimbursement to 2026 and beyond. The high-stakes legislative battles of the past several years over the “doc fix” and annual updates is over as a new physician payment system has been defined • Steven Lash, noted healthcare strategic advisor said “As a result of MACRA, from July 2015 through 2019, physicians will be guaranteed a 0.5% update. From January 2020 through 2025, the law includes a zero percent update; but, some providers will get annual bonuses and others will get annual awards or penalties.”
Steven Lash continued his comments adding that there are 2 new questions that will need to be answered.
• How can physicians avoid the 4-9% cuts to reimbursement which could be imposed beginning in 2019 under Medicare’s new payfor-performance system? • How can physicians get exempted from the new pay-for-performance system altogether and lock-in annual bonuses of 5% per year starting in 2019?
• The legislation provides the broad answer to these questions: Physicians must begin to participate in “alternative” value-based payment models. What those models will be is substantially to be determined. • Already, MACRA has replaced the 20% cut to physician reimbursement threatened by the SGR (Sustainable Growth Rate) with more-or-less status quo updates annually beginning in 2015 and running through 2019 to be followed by an update freeze through 2025. • Between now and 2019, several new and existing entities have been tasked with answering the two questions above: what will the new payfor-performance system look like and how can physicians opt out of it and into a bonus-based alternative?
Thank You Steven Lash