ments, with other incentives in 2026 and beyond. MACRA also strives to make the
APM track more accessible, Dr. Lock- hart says, by allowing for a wide va- riety of models, including specialty- focused models, those geared toward smaller practices, and multipayer projects. Also, a certain percentage of APM patients can be covered by non- Medicare payers. CMS’ Innovation Center (http://in
novation.cms.gov) touts a growing list of potentially qualifying APMs that can include, but go well beyond, ACOs. Examples are:
• Bundled payments for care im- provements.
• Primary care transformation mod- els, such as medical homes and co- ordinated care demonstrations for patients with chronic conditions.
“We can’t just sit on this victory. Having physician input in what is ahead is as important as getting rid of SGR itself.”
• Initiatives focused on dual-eligible Medicare-Medicaid patients, in- cluding a Texas demonstration project already underway. (See “Dual Dilemma,” May 2014 Texas Medicine, pages 33–39, or www.tex
med.org/DualDilemma.)
• Initiatives to accelerate the devel- opment and testing of new pay- ment and service delivery models, such as for specific patient popula- tions or specialties.
• Initiatives to speed the adoption of best practices, such as the Million Hearts campaign to prevent 1 mil- lion strokes and heart attacks over five years. (See “Saving 1 Million Lives,” June 2015 Texas Medicine, pages 39–44, or
www.texmed.org/ MillionHearts.)
According to The Physicians Foun-
dation report, the APM pathway is “less fleshed out in the law and pro- vides even greater areas of debate and uncertainty, but also, perhaps oppor- tunity.”
+ 60 TEXAS MEDICINE September 2015
GETTING READY Dr. Lockhart says MACRA will hope- fully “lead to a better definition of val- ue-based care, when it hasn’t always been clear how to get there.” Although some predict more consolidation as a result of the new law, he says there are ways for physicians to join forces without losing autonomy. The MIPS and APM tracks, for
instance, allow room for small physi- cian groups to loosely join in “virtual” organizations — rather than legal entities like ACOs or professional as- sociations — to combine the groups’ performance, data, and resources, and better generate efficiencies and improvements. A virtual organization might be a regional, clinically integrat- ed network or an at-risk independent practice association, for example, Dr. Lockhart explains. Small physician groups “make up
a pretty high percentage of practices in Texas, and the biggest advantage they have is TMA PracticeEdge [www
.tmapracticeedge.com] to help create those kinds of economies of scale,” he said.
MACRA also provides $100 mil-
lion over five years for state qual- ity improvement organizations — like the TMF Health Quality Institute in Texas (
www.tmfqin.org) — regional extension centers, and other entities to provide small and rural practices with technical assistance to imple- ment MIPS or transition into APMs. Physicians still have time to decide
which pathway to choose, “but not a lot of time,” says national health care consultant and BizMed cofounder Margalit Gur-Arie. At the very least, she recommends
physicians maintain their participa- tion in PQRS and meaningful use and start tracking quality measures — not just report them — to prepare for MIPS. Even now, she says, doing noth- ing will result in financial penalties.
Physicians Foundation report: tma.tips/MedicareWatchList
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