blog post 7.18.14

Will the New Administration Derail the Quality Payment Program? Podcast

Jesus "Chuy" Ramirez

Patient Experience Trainer, Performance Improvement and Research

HealthStream’s Second Opinions Podcast series features industry experts and leaders and their take on issues impacting healthcare today and tomorrow.

In our first installment, we interview Dr. Miles Snowden, the Chief Medical Officer at TeamHealth. He shares his personal insight on the Medicare Access and CHIP Reauthorization Act (MACRA), and what it means for physicians, hospitals, and consumers. Dr. Snowden has seen a lot of changes throughout his career, but none so impactful as the implementation of the Merit-based Incentive Payment System.


Below is a short excerpt from the recording with HealthStream’s Brad Weeks, our host:


Do you see the new administration potentially derailing implementation of the Quality Payment Program?

Dr. Snowden:

I don't think the physician community has either the patience or the ability to wait to see what will result from change in administration as pertains to the final rule on MACRA. We have been given, call it a six month forbearance in 2017 to allow us to ease into the program, by virtue only of reporting on a single quarter in 2017. Most physicians that I have spoken with are thinking about doing the gathering of data in the third and fourth quarter, picking the most favorable quarter and then using that as their reporting. So you could argue that we've been given a six month respite on the program; but six months is the minimum necessary to get ready to perform in the third or the fourth quarter of 2017. So I don't think any prudent physician would currently be sitting doing nothing and awaiting to see what the administration's going to be doing. We can't. This program is introducing penalties and incentives that are going to range from 4-9%. This is a make or break sort of program not one that you can opine about the potential effect and wait to see. So, I don't know any physician who has not accepted that we have a final rule, and that final rule is how we'll be practicing medicine within the next couple of years at a minimum.


Under the Quality Payment Program, clinicians also have the opportunity to bypass MIPS reporting if they participate in an advanced alternative payment model. As I understand it this would qualify them for an automatic 5 percent incentive payment. Do you see a rush for practices to sign up for these risk-based care models?

Dr. Snowden:

My particular group is one of the largest participants in the Bundled Payments for Care Improvement Initiatives. One might argue that if anyone was bullish about taking advantage of the Advanced Alternative Payment Models, it might be a group such as my own assuming that Bundle Payments for Care Improvement or BPCI is qualified as an advanced APM in some upcoming sub-regulatory guidance.

We expect that will occur yet we are particularly optimistic that the advanced APM will be a good option for us. So why would we feel that way, and I do believe that that is representative of groups in general who are not overly excited about the advanced APM as it's currently described in the final rule. And that is that the hurdle to qualify 20 and 25% of either reimbursement dollars or patients encounters is too high. There just are very, very few physician group practices or individual physicians who would have that portion of their patient encounters or reimbursement dollars attributable to qualified advanced APM Models of care.

If the hurdle was lower, call it 10%, 15%, I would be pretty excited about that because the opportunity to avoid penalties and gain incentive payments around this is very attractive and very robust. It's very enticing but when you read the rules and you see the hurdle in terms of volume, it looks unattainable for the vast majority of groups.

Listen to the podcast here.

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