Sustainable Growth Rate Repealed, MACRA Revealed: Historical Context and Analysis of Recent Changes in Medicare Physician Payment Methodologies

Hirsch, Joshua A; Harvey, H. Benjamin; Barr, Robert M.; Donovan, William D.; Duszak, Richard; Nicola, Gregory N.; Schaefer, Pamela W.; Manchikanti, Laxmaiah

doi:10.3174/ajnr.a4522

Cited by 39 publications

(19 citation statements)

References 13 publications

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“…This approach is in keeping with our aforementioned recommendation for data collection and quality control. 141,142 The interventionalist who performed the specific case under review should be present to offer his/her observations and perspective. The focused endovascular peer review should routinely include assessment of technical factors such as device choice, supplemental lytic agent infusion, and equipment inventory assessment.…”

Section: Review Processmentioning

confidence: 99%

Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

Sacks

Baxter

Campbell

et al. 2018

AJNR Am J Neuroradiol

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193

179

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ABBREVIATIONS: ASPECTS ϭ Alberta Stroke Program Early Computed Tomography Score; EVT ϭ endovascular therapy; mRS ϭ modified Rankin Scale; mTICI ϭ modified thrombolysis in cerebral infarction; NIHSS ϭ National Institutes of Health Stroke Scale; QI ϭ quality improvement; SAH ϭ subarachnoid hemorrhage; SICH ϭ symptomatic intracranial hemorrhage; SITS-MOST ϭ Safe Implementation of Thrombolysis in Stroke Monitoring Study; TICI ϭ thrombolysis in cerebral infarction; TIMI ϭ thrombolysis in myocardial infarction; TPA ϭ tissue plasminogen activator E ndovascular therapy (EVT) for acute ischemic stroke in selected patients has recently been proved effective in several clinical trials, and the widespread adoption of thrombectomy into routine clinical practice has begun. However, these acute stroke services are resource-intensive, including advanced cerebral im-aging and highly trained multidisciplinary hospital teams rapidly responding to emergency activation. Despite the previous acceptance of intravenous fibrinolysis for acute ischemic stroke and the development of designated stroke centers, 1 ischemic stroke remains a leading cause of adult death and disability. 2 Many patients are not candidates for fibrinolysis, and intravenous therapy is relatively ineffective for severe strokes as a result of large cerebral artery occlusions. Moreover, it is uncertain if the benefits of endovascular stroke treatment in the trial setting can be generalized to clinical care provided by hospitals and teams of varying training, experience, and case volume. In other medical disciplines, rapid technologic advancement required guidelines to utilize these tools effectively and responsibly. 3 Quality-improvement (QI) metrics for the outcomes of endovascular ischemic stroke treatment were published by a multisociety, multispecialty, international consensus group in 2013. 4 These QI metrics have been accepted at a national level in Great Britain and Ireland 5 but have yet to be included into stroke center accreditation requirements in the United States. Subsequent to the publication of the prior QI guidelines, eight randomized trials and several meta-analyses of EVT have been published. 6-20 These randomized trials have established EVT as standard of care when available, 5,21-23 and provide additional data on which to update the metrics and bench-

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Section: Review Processmentioning

confidence: 99%

Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

Sacks

Baxter

Campbell

et al. 2018

AJNR Am J Neuroradiol

Self Cite

193

179

View full text Add to dashboard Cite

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“…The criticality of this approach cannot be overstated. Beyond allowing for measures that are specifically relevant to neurointerventional specialists, a far greater flexibility will exist than what was covered in the CMS proposed MACRA rule 12. QCDR can nominate up to 30 non-MIPS measures for review by CMS and approved for reporting purposes.…”

Section: Merit Based Incentive Payments Systemmentioning

confidence: 99%

MACRA 2.0: are you ready for MIPS?

Hirsch

Rosenkrantz

Ansari

et al. 2016

J NeuroIntervent Surg

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The annual cost of healthcare delivery in the USA now exceeds US$3 trillion. Fee for service methodology is often implicated as a cause of this exceedingly high figure. The Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) to pilot test value based alternative payments for reimbursing physician services. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law. MACRA has dramatic implications for all US based healthcare providers. MACRA permanently repealed the Medicare Sustainable Growth Rate so as to stabilize physician part B Medicare payments, consolidated pre-existing federal performance programs into the Merit based Incentive Payments System (MIPS), and legislatively mandated new approaches to paying clinicians. Neurointerventionalists will predominantly participate in MIPS. MIPS unifies, updates, and streamlines previously existing federal performance programs, thereby reducing onerous redundancies and overall administrative burden, while consolidating performance based payment adjustments. While MIPS may be perceived as a straightforward continuation of fee for service methodology with performance modifiers, MIPS is better viewed as a stepping stone toward eventually adopting alternative payment models in later years. In October 2016, the Centers for Medicare and Medicaid Services (CMS) released a final rule for MACRA implementation, providing greater clarity regarding 2017 requirements. The final rule provides a range of options for easing MIPS reporting requirements in the first performance year. Nonetheless, taking the newly offered 'minimum possible' approach toward meeting the requirements will still have negative consequences for providers.

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“…As outlined previously, it pushed forward the agenda of transforming the FFS volume-based US healthcare delivery system into one that is value-driven 9 10. An important component of MACRA was expansion of episode groups, representing sets of all rendered services relating to a given clinical condition or diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The episode, the PTAC, cost, and the neurointerventionalist

Hirsch

Rosenkrantz

Liu

et al. 2016

J NeuroIntervent Surg

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Episodic care forms a payment methodology of increasing relevance to neurointerventional specialists and other providers. Episodic care payment models are currently recognized in both payment paths described by the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA): the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. Understanding the cost of care, as well as how such costs are shaped in the context of episodic care, will be critical to success in both of these paths.

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Sustainable Growth Rate Repealed, MACRA Revealed: Historical Context and Analysis of Recent Changes in Medicare Physician Payment Methodologies

Cited by 39 publications

References 13 publications

Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

MACRA 2.0: are you ready for MIPS?

The episode, the PTAC, cost, and the neurointerventionalist

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