Important Payment Information for Every Hospitalist to Know

In 2015,  the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) into law, altering the future of the Medicare payment system for providers.

MACRA removed the Sustainable Growth Rate, and instead focused on quality measure development, expanded the use of Medicare data, and locked provider payment rates to near zero growth.

For Medicare payments, MACRA created the Quality Payment Program, which breaks the clinical payments into two different pathways: the Merit-Based Incentive Payment System (MIPS) combining current pay-for-performance programs into one consolidated payment system, and Alternative Payment Models (APMs), incentivizing payment models that move away from a fee-for-service system.

Starting in 2019, clinician Medicare payment adjustments will depend on which track the provider or the provider’s hospitalist group chooses to participate in. The Centers for Medicare & Medicaid Services will use 2017 data to determine 2019 payment adjustments.

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