Narayanaswami Pushpa, Suk Millie, Jones Lyell K
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
American Association of Neuromuscular & Electrodiagnostic Medicine, Rochester, Minnesota, USA.
Muscle Nerve. 2017 Oct;56(4):679-683. doi: 10.1002/mus.25699. Epub 2017 Jul 7.
Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. Here we review emerging trends in development of value-based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value-based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists. Muscle Nerve 56: 679-683, 2017.
从2017年开始，大多数参与医疗保险的医生都要遵守《医疗保险准入与儿童健康保险计划再授权法案》（MACRA），这项具有里程碑意义的立法标志着美国医疗保健系统从基于数量的医疗模式向基于价值的医疗模式转变。在此，我们回顾美国基于价值的医疗保健系统发展中的新趋势。MACRA以及由此产生的质量支付计划创建了两条参与途径，即基于绩效的激励支付系统（MIPS）和高级替代支付模式（AAPM）途径。尽管参与AAPM有多项计划激励措施，但迄今为止，针对专科医生的AAPM选项很少。MIPS及其不断扩大的奖励和惩罚范围可能会成为该计划早期的主要参与途径。基于价值的支付有可能重塑美国的医疗服务提供方式，这对神经肌肉和电诊断（EDX）专科医生也有影响。神经肌肉和EDX专科医生需要有意义的质量指标。《肌肉与神经》56: 679 - 683, 2017年。
