A Look at MACRA: What to Expect in 2017.

The Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 fundamentally changes how physicians who care for Medicare patients will be paid. Although physicians won't see changes in their payments in 2017, they need to understand that their performance in 2017 will be the basis for the payments made to them starting in 2019. This article summarizes the two paths for determining future Medicare payments established by the law: the merit-based incentive payment system and advanced alternative payment models.

Medicare program; changes to the electronic prescribing (eRx) incentive program. Final rule.

This final rule modifies the electronic prescribing (eRx) quality measure used for certain reporting periods in calendar year (CY) 2011; provides additional significant hardship exemption categories for eligible professionals and group practices to request an exemption during 2011 for the 2012 eRx payment adjustment due to a significant hardship; and extends the deadline for submitting requests for consideration for the two significant hardship exemption categories for the 2012 eRx payment adjustment that were finalized in the CY 2011 Medicare Physician Fee Schedule final rule with comment period.

MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026. Existing APMs are most relevant to primary care physicians, and opportunities for radiologists to participate in Advanced APMs fulfilling Qualified Participant requirements are limited. Physician-Focused Payment Models (PFPMs), as described in MACRA, are APMs that target physicians' Medicare payments based on quality and cost of physician services. PFPMs must address a new issue or specialty compared with existing APMs and will thus foster a more diverse range of APMs encompassing a wider range of specialties. The PFPM Technical Advisory Committee is a new independent agency that will review proposals for new PFPMs and provide recommendations to CMS regarding their approval. The PFPM Technical Advisory Committee comprises largely primary care physicians and health policy experts and is not required to consult clinical experts when reviewing new specialist-proposed PFPMs. As PFPMs provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, radiologists should embrace this new model and actively partner with other stakeholders in developing radiology-relevant PFPMs.

Health Care Financing Administration's new regulations for financial incentives in Medicaid and Medicare managed care: one step forward?

Because financial incentives for managed care physicians may create conflicts of interests, new regulations have been instituted that will result in disclosure of certain financial incentives to the Federal Government and to some patients. Given the limitations of these regulations, health plans and physicians should take the lead in addressing concerns about the harmful effects of financial incentives. For example, public disclosure may deter unusually strong financial incentives. Purchasing coalitions, advocacy groups, and journalists should have increased access to information about physician-level incentives. These nonregulatory measures might reassure patients that managed care physicians are committed to their best interests.

Ontario's underserviced area program revisited: an indirect analysis.

Financial incentive programs are used in various developed and developing countries to effect change in the geographic distribution of physicians. The Underserviced Area Program of Ontario is the longest running financial incentive program in Canada. It is described in detail and analyzed for its effectiveness in solving the problems of the maldistribution of physicians in northern Ontario. Using location quotients as an indirect measure shows that the maldistribution of physicians continues despite the implementation of the program. It is argued that the unidimensional solution of financial incentives cannot be used to solve the multidimensional issue of accessibility to health care in rural and remote areas.

Physician recruiting under the microscope.

Although recruiting physicians into existing practices is a time-honored way for hospitals to bolster their staffs, hospitals and physicians may need to rethink this practice in light of increased scrutiny from federal regulators. In June 2003, federal prosecutors filed charges against Alvarado Hospital Medical Center and its former chief executive, Barry Weinbaum, alleging that they had "bribed" doctors with relocation agreements in exchange for the doctors' referral of patients. The charges against Alvarado may not be an isolated event.

Medicare and Medicaid programs; requirements for physician incentive plans in prepaid health care organizations--HCFA. Final rule.

This final rule amends the regulations established by a March 27, 1996, final rule with comment period. The regulations govern physician incentive plans operated by Federally-qualified health maintenance organizations and competitive medical plans contracting with the Medicare program, and certain health maintenance organizations and health insuring organizations contracting with the Medicaid program. As explained in the March 27 rule, the provisions of this final rule will also have an effect on certain entities subject to the physician referral rules in section 1877 of the Social Security Act.

Certain physician recruitment and retention activities found to be suspect.

A new "Fraud Alert" from the Office of Inspector General of the Department of Health and Human Services will cause hospitals to be especially circumspect in their dealings with actual and potential members of the medical staff. The authors analyze the alert and its potential impact on hospitals and physicians.