Some more details for those who have read this far: If you run a practice, then you know that MACRA is the law that repealed SGR and, as of Jan. 1, 2017, dictates your reimbursement for seeing Medicare and Medicaid patients. It’s been widely reported that there are two pathways under MACRA: MIPS and APMs.
What that over-simplified explanation does not convey is that 1) both CMS and Congress are strongly incentivizing physicians to join APMs; 2) all accepted APMs to date have been created by payers; and 3) the MACRA legislation explicitly encourages the creation of “physician-focused” APMs. Indeed, Dr. Tom Price, recently confirmed as Secretary of HHS (which oversees Medicare and Medicaid), has expressed his support for physician-focused solutions.
Therefore, the APM group at the ACR, with the expert guidance of Harold Miller from the Center for Healthcare Quality and Payment Reform, and in coordination with similar efforts by other cognitive subspecialty societies, is constructing a rheumatology-focused APM. This physician-focused APM is being designed to serve as a model that can be modified, adapted, and adopted on a completely voluntary basis by practices around the country that wish to pursue such a path – and for whom MIPS and conventional APMs hold little attraction.
A rheumatology-focused APM won’t solve all our problems. But if done properly, it does offer a genuine opportunity to align reimbursement with cognitive work, reduce the cost of care, and reward high-value care. The alternative is a pathway designed by and for non-rheumatologists. The APM group at the ACR thinks there is a better way.
Doug White, MD, chairs the ACR’s Committee on Rheumatologic Care (CORC). *A committee with a memorable but uninformative name, CORC was created years ago to enhance the voice of ACR members in practice. One of our most important duties, working alongside the Insurance Subcommittee and the Affiliate Society Council, is to help practicing rheumatologists navigate payment reform.
