Kinker Brenton, Dobesh Kaitlyn, Nassiri Nariman, Juzych Mark S, Wilson M Roy
Kresge Eye Institute, School of Medicine, Wayne State University, Detroit, Michigan.
Wayne State University, Detroit, Michigan.
Am J Ophthalmol. 2017 Jul;179:1-9. doi: 10.1016/j.ajo.2017.04.002. Epub 2017 Apr 14.
To analyze the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on the field of ophthalmology.
A perspective on the effects of MACRA's Quality Payment Program after analysis of the proposed rule, final rule, and commentary submitted by relevant stakeholders.
Physicians will need to use 1 of 2 payment structures: Merit-Based Incentive Payment Systems (MIPS) or Alternative Payment Models (APMs). APMs and MIPS will focus on bundling payments and reimbursing based on "fee-for-service-plus" models, which take into account clinical outcomes, coordination of care, clinical improvement, and electronic information exchange and security. APMs have substantial advantages, with eligible participants receiving a bonus and a higher rate of annual adjustment over the program's life. For most ophthalmology practices, MIPS may be more appropriate owing to its broader applicability and the current paucity of APMs for ophthalmologists.
The Quality Payment Program is a substantial improvement over the negative adjustments under the repealed Substantial Growth Rate model. Ophthalmologists will likely use the MIPS system; however, its comparatively lower reimbursements, as well as its cost, quality, and other reporting measures, may prove problematic.
分析2015年《医疗保险准入与儿童健康保险计划再授权法案》（MACRA）对眼科领域的影响。
在分析相关利益相关者提交的拟议规则、最终规则和评论后，对MACRA质量支付计划的影响进行展望。
医生将需要使用两种支付结构中的一种：基于绩效的激励支付系统（MIPS）或替代支付模式（APM）。APM和MIPS将专注于捆绑支付，并基于“服务收费加”模式进行报销，该模式会考虑临床结果、护理协调、临床改善以及电子信息交换与安全。APM具有显著优势，符合条件的参与者在该计划实施期间将获得奖金以及更高的年度调整率。对于大多数眼科医疗机构而言，由于MIPS的适用性更广且目前眼科医生适用的APM较少，MIPS可能更为合适。
质量支付计划相较于已废除的大幅增长率模型下的负面调整有了实质性改进。眼科医生可能会使用MIPS系统；然而，其相对较低的报销额以及成本、质量和其他报告措施可能会带来问题。
