Squitieri Lee, Chung Kevin C
Los Angeles, Calif.; and Ann Arbor, Mich.
From the Robert Wood Johnson Clinical Scholars Program, David Geffen School of Medicine, the Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of California, Los Angeles; the U.S. Department of Veterans Affairs Greater Los Angeles Health System; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Medical School.
Plast Reconstr Surg. 2017 Jul;140(1):205-214. doi: 10.1097/PRS.0000000000003431.
In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.
2015年，美国国会通过了《医疗保险准入与儿童健康保险计划再授权法案》，该法案实际上废除了医疗保险与医疗补助服务中心的可持续增长率公式，并设立了医疗保险与医疗补助服务中心质量支付计划。《医疗保险准入与儿童健康保险计划再授权法案》代表了向基于价值的支付模式的空前加速推进，以及对传统的量驱动型按服务收费报销方式的背离。质量支付计划包括提供者参与的两条途径：基于绩效的激励支付系统和高级替代支付模式。基于绩效的激励支付系统途径取代了现有的质量报告计划，并增加了几项新措施，为每个提供者（或提供者团体）创建一个综合绩效得分，该得分将用于调整报销支付。高级替代支付模式途径可供参与符合条件的高级替代支付模式的提供者使用，并与初始5%的支付激励相关联。基于绩效的激励支付系统的第一个绩效期从2017年1月1日开始，到2017年12月31日结束，并与2019年1月的支付调整相关联。医疗保险与医疗补助服务中心估计，大多数提供者将在2017年通过基于绩效的激励支付系统途径开始参与，但目标是到2018年有50%的支付与通过高级替代支付模式的质量或价值挂钩。在本文中，作者向正在通过质量支付计划的提供者描述了《医疗保险准入与儿童健康保险计划再授权法案》的关键组成部分，并讨论了整形外科医生如何在这个新的基于价值的支付计划中优化他们的表现。
