Huston Kent Kwasind
From the Center for Rheumatic Disease, Kansas City, MO.
J Clin Rheumatol. 2017 Apr;23(3):167-168. doi: 10.1097/RHU.0000000000000504.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 introduced a new system of physician payments in the United States. This legislation and the complex rules written to enact the law intend to force a shift away from volume-based payments and into so called value-based payments. Physicians and other clinicians will be graded via quality and cost metrics and payments will be adjusted based on performance. Robust use of certified electronic health records is required under MACRA. Physicians will follow one of two payment reform tracks known as the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) pathways. Although there are rheumatology and other specialty specific quality measures in the MIPS program, there are no rheumatology specific APMs to date. A thorough understating of MACRA is required for medical practices to survive the new era of payment reform.
2015年的《医疗保险准入与儿童健康保险计划再授权法案》（MACRA）在美国引入了一种新的医生薪酬体系。这项立法以及为实施该法律而制定的复杂规则旨在促使从基于数量的支付方式转向所谓的基于价值的支付方式。医生和其他临床医生将通过质量和成本指标进行评分，薪酬将根据绩效进行调整。MACRA要求大力使用经过认证的电子健康记录。医生将遵循两种支付改革路径之一，即基于绩效的激励支付系统（MIPS）和替代支付模式（APM）路径。尽管MIPS计划中有针对风湿病学和其他专科的质量措施，但迄今为止尚无针对风湿病学的特定APM。医疗实践要在支付改革的新时代中生存下去，就需要全面了解MACRA。
