Four years ago, healthcare took a giant leap toward becoming value-based when Congress passed the Medicare Access and Chip Reauthorization Act. In the nearly half-decade since, providers have had to learn a variety of new programs—and, like always, acronyms. Many of our readers may be familiar with each of these. However, the world of value-based care is constantly changing, and a (very) brief refresher course on the programs, legislation, and acronyms that influence value-based care under Medicare may be worth getting a refresher on. Here are a few of the terms you may hear during the Model Year 3 applicant submission period (April 24, 2019 – June 24, 2019): MACRA: The acronym for the Medicare Access and Chip Reauthorization Act, MACRA mandated the Center for Medicare and Medicaid Services (CMS) to implement a program called the Quality Payment Program (QPP). QPP changes the way physicians are paid in Medicare by creating a two-track system for physician payments. MIPS: The Merit-Based Incentive Payment System (MIPS) is one of the two new ways physicians can change how they receive payments from CMS. Under MIPS, providers are required to report a range of performance metrics. CMS will then adjust payments based on performance. (Fusion5 Educational Opportunity: Interested in learning more about navigating MACRA and MIPS? Register for our free webinar “MACRA & MIPS – How To Navigate” on May 22, 2019, at 12:00 Central!) Advanced APM: The Advanced Alternative Payment Model (Advanced APM) is also one of the two new ways physicians can change how they receive payments from CMS. Physicians and providers participating in a program under the Advanced APM track take on financial risk to earn the Advanced APM incentive payment. BPCI-A: The Bundled Payment for Care Improvement – Advanced (BPCI-A) program falls under the Advanced APM tracks. Participants are required to keep Medicare expenditures within a predetermined budget. While emphasizing cost containment, BPCI-A also requires participating providers to improve quality on specific measures in order to receive incentive payments. With about a month left until the close of the Model Year 3 deadline on June 24, 2019, we strongly encourage physician group practices (PGPs) and acute care hospitals (ACHs) to request their FREE data analysis and schedule a BPCI-A consultation with our team. (Fusion5 Educational Opportunity: For more advanced analysis and information on all things BPCI-A, please read the latest from value-based care’s most insightful thought leaders on the Fusion5 blog. For specific analysis on Model Year 3, please read our Model Year 3 FAQ.) Convener: Under a convener agreement, providers and physicians partner with an organization (that then serves as the designated convener) to share downside risk and access sufficient capital. Conveners also deliver clinical expertise, care redesign, technology, education, administrative, financial, and other services. Conveners essentially deliver the resources and expertise required to make the enormous potential of BPCI-A a reality for providers and physicians. Conveners must apply to and be approved by CMS. Fusion5: The nation’s fastest-growing and largest orthopedic convener, Fusion5 partners with physician group practices, acute care hospitals, and other healthcare providers to support them with our innovative technology-based care management system that improves quality, reduces cost, and increases profitability. On the commercial side, our team also works with labor unions, state and local governments, self-insurers, and other organizations to decrease the cost and improve the quality of care they provide to members and employees. We do this by fusing our five core services: – Care redesign support – Administrative and financial solutions – Provider network development and management – Education and research – Technology and data analytics Fusion5 is committed to providing cutting-edge, advanced information on the latest changes in the value-based care and bundled-payment world. However, sometimes it doesn’t hurt to brush up on the fundamentals—especially in an industry that changes so quickly and is so complex. Interested in learning more? Contact us today! We would be glad to help you leverage the power of bundled payments and value-based care to strengthen your quality of care—and your bottom line.

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