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.

Redesigning provider payment: Opportunities and challenges from the Hawaii experience.

OBJECTIVES: To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system STUDY DESIGN: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the organizational level and this initiative focused on changing the incentives for individual providers. METHODS: Descriptive paper. In this paper we discuss the approach taken to shift incentives from fee-for-service towards value using behavioral economics as a conceptual framework for program design. We summarize the new payment system, challenges in its design, and our approach to piloting of different behavioral economic strategies to improve performance. RESULTS: None. CONCLUSIONS: This paper will provide useful guidance to health plans or health delivery systems considering shifting primary care payment away from fee-for-service towards value highlighting some of the design challenges and necessary compromises in implementing such a system at scale.

For Medicare's New Approach To Physician Payment, Big Questions Remain.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established a new framework for Medicare physician payment. Designed to stabilize uncertain payment rates for Medicare's fee-for-service (FFS) system and incentivize physicians to move into new alternative payment systems, MACRA contains several uncertainties of its own. In a textbook illustration of why it's important to be careful what you wish for, it's increasingly easy to predict that implementation of MACRA will be delayed as a result of both regulatory and legislative breaches of its statutory timeline. This article traces the contemporary history of the Medicare physician payment system and efforts to implement additional changes.

Number of P4P initiatives doubles in last two years.

Some experts predict the use of capitation will increase as health plans and government rely more heavily on paying providers for quality improvement. Early results from a Medicare P4P demonstration project for hospitals firms up the belief by many that P4P will soon be used in Medicare Advantage.

California Blue Cross redirects incentive dollars from UM to quality.

In its realignment of physician incentives, a California plan has taken money away from the utilization management bonus pool and put it into quality. Here are the details.

The siren song of physician incentives: avoiding the rocks.

As the United States attempts to reform its health care system, various incentive programs are playing an increasingly important role. In this review, the primary dynamics that drive the rise of incentives in health care management are discussed. Increasingly well-designed studies on the impact of incentives on outcomes continue to yield variable and, at times, unexpected results. The incorporation of incentives into the overall process of organizational cultural change is an important tool but one with significant limitations.

Rural implications of the Primary Care incentive Payment Program.

Key Findings. (1) Both the number and proportion of providers eligible to receive Primary Care Incentive Payments in 2011, 2012, and 2013 increased during the years used to determine eligibility (2009, 2010, and 2011). (2) For most practice types, rural providers were more likely to be eligible for Primary Care Incentive Payments. However, rates of eligibility varied between provider types. (3) Rural Family Practice physicians were less likely to be eligible for Primary Care Incentive Payments than their urban counterparts.

Can money buy quality? Physician response to pay for performance.

While pay for performance (P4P) has created a nationwide buzz among health plans, physicians and hospitals, most P4P initiatives are still on the drawing board, according to findings from the Center for Studying Health System Change's (HSC) 2005 site visits to 12 nationally representative communities. HSC focused on performance-based payment for physicians, finding that only two HSC communities-Orange County, Calif., and Boston-have significant physician P4P programs. In the other 10 communities, where almost no physicians have received quality-related payments to date, physician attitudes about P4P ranged from skeptical to hostile. P4P, a concept best suited to larger physician groups, may be difficult to implement in markets dominated by small physician practices. In spite of substantial barriers to initiating performance-related payment for physicians, most large health plans and Medicare are planning P4P programs.

Expected HMO premium increase: more money for hospitals, physicians?

Lagging HMO revenues and profits over the past few years have resulted in declining or stagnant reimbursement rates paid to providers nationally. Over the next year, however, average national premium rates are expected to rise, giving HMOs more financial flexibility and providers reason to be cautiously optimistic about possible increases paid to hospitals and physicians.