skip navigation

First Phase of the Physician SGR Overhaul – MACRA’s Quality Framework Plan – Is Coming This May; More on Alternative Payment Models (APMs) for Orthopaedic Surgeons

March 3, 2016

Last Spring, Congress passed the Medicare Payment and CHIP Reauthorization Act (MACRA), which replaced the Medicare physician payment SGR formula with two new avenues for Medicare physician payment:

  • MIPS (Merit-based Incentive Payment System) – This path allows physicians to receive bonuses based on quality reporting.
  • APM (Alternative Payment Model) – This path allows physicians to receive bonuses based on being part of new payment models, such as accountable care organizations (ACOs) or bundled payments.

Since orthopaedic surgeons are limited in their ACO options, the APM option may be more difficult for most surgeons. Organized medicine is exploring alternative payment model options for surgeons.  Click here for more information about an AAOS initiative with the American College of Surgeons and Brandeis University.  The initial focus will be on rotator cuff repairs, knee arthroscopies, and hip fractures.

TOA also told you about the Perioperative Surgical Home, which is managed by the American Society of Anesthesiologists and could incorporate surgeons.  Click here.

A significant aspect of MACRA – the Quality Measurement Development Plan (QMDP) – will be released in May 2016. This creates the framework for clinician quality measure development to support the MIPS quality payments.

CMS accepted comments regarding the QMDP up until March 1, 2016.  It is expected to release the plan in May 2016.

Click here for more information.