Alternative Payment Models in Radiology: The Legislative and Regulatory Roadmap for Reform

Abstract

The Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on the Merit-Based Incentive Payment System and incentives for alternative payment model participation. It is important that radiologists understand the statutory requirements of MACRA. This includes the nature of the Merit-Based Incentive Payment System composite performance score and its impact on payments. The timeline for MACRA implementation is fairly aggressive and includes a robust effort to define episode groups, which include radiologic services. A number of organizations, including the ACR, are commenting on the structure of MACRA-directed initiatives.

Keywords: Center for Medicare and Medicaid Innovation (CMMI); Health Care Payment and Action Network (HCPLAN); Medicare Access and CHIP Reauthorization Act (MACRA); Merit-Based Incentive Payment System (MIPS); Physician Quality Reporting System (PQRS); alternative payment models (APMs); clinical practice quality improvement activities; episode groups; resource use.