Kaye Deborah R, Miller David C, Ellimoottil Chad
aInstitute for Healthcare Policy and Innovation, University of Michigan bDow Division of Health Services Research, Department of Urology, Ann Arbor, Michigan, USA.
Curr Opin Urol. 2017 Jul;27(4):360-365. doi: 10.1097/MOU.0000000000000403.
The Medicare Access and CHIP Reauthorization Act (MACRA) is a historic bill that was recently passed that establishes how quality measurement and practice patterns will affect physician reimbursement. Alternative payment models (APMs) are an essential component of MACRA and Medicare's vision of paying for high-value care. This review describes APMs in the context of MACRA and their impact on urology.
The majority of urologists will be affected by MACRA. Both APMs and bundled payments are considered APMs under MACRA. Although most urologists do not currently participate in Accountable Care Organizations (ACOs) and Bundled Payments, both models are considered APMs under MACRA and are likely going to gain increasing attention in the coming years.
APMs will likely become more relevant to urologists' practices in the future, as both the Centers for Medicare and Medicaid Services and private payers are transitioning away from fee-for-service towards value-based payment.
《医疗保险获取与儿童健康保险计划再授权法案》（MACRA）是一项近期通过的具有历史意义的法案，它规定了质量评估和执业模式将如何影响医生的报销。替代支付模式（APM）是MACRA以及医疗保险为高价值医疗付费愿景的重要组成部分。本综述在MACRA背景下描述APM及其对泌尿外科的影响。
大多数泌尿外科医生将受到MACRA的影响。APM和捆绑支付在MACRA下均被视为APM。尽管目前大多数泌尿外科医生未参与责任医疗组织（ACO）和捆绑支付，但这两种模式在MACRA下均被视为APM，且在未来几年可能会受到越来越多的关注。
随着医疗保险和医疗补助服务中心以及私人支付方都在从按服务收费转向基于价值的支付，APM未来可能会与泌尿外科医生的执业更加相关。
