The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed last April ended the Sustainable Growth Rate (SGR) formula for determining Medicare payments to health care providers, creating a new pathway to value base payments. Future fee schedule adjustments will be driven by participation in either (1) a Merit-Based Incentive Payment System (MIPS) that combines existing quality reporting and incentive programs or (2) qualified Alternative Payment Models (APMs) that require providers take on a yet to be defined "more than nominal" financial risk. Given the complexity of MIPS and long-term potential higher earnings under APMs, many physicians are interested in preparing for participation in APMs and see the current Medicare Shared Saving Program (MSSP) as a logical stepping stone.
As more physicians in the U.S. move into Accountable Care Organizations (ACOs) and the MSSP their peers are watching their successes and struggles, trying to discern what drives the difference in the 28 percent that are reaping shared savings and the great majority that are not. MSSP requires ACOs to hit savings targets benchmarked from their existing spending patterns, as well as score well on 33 quality measures. What is needed to prepare to successfully engage under these new payments models? A useful reference is the Brookings white paper on "Adopting Accountable Care: An Implementation Guide for Physician Practices". This toolkit identifies four capacities critical for success: (1) identify and managing high-risk patients; (2) develop high-value referral networks; (3) receive notifications of acute events such as emergency room (ER) visits or hospitalizations; and (4) engage patients in self-management and shared decision-making.