decisionhealth Newsletters, Coder Pink Sheets - 2015 Issue 6 (June)
With SGR repealed, payment predictability, value-based fees settle in for practices
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Article Overview
This article reviews Medicare physician payment changes following repeal of the sustainable growth rate formula and outlines the new payment path established by the Medicare Access and CHIP Reauthorization Act of 2015. It also covers the move toward value-based reimbursement, participation in alternative payment models, and the consolidation of major quality reporting programs. The piece is aimed at physicians, practice administrators, and coding or reimbursement professionals who need to understand how federal payment policy and reporting requirements are changing.
Why This Topic Matters
These policy changes affect how Medicare pays practices, how incentives are structured, and how quality reporting programs will be organized going forward. Understanding the shift helps practices plan for reimbursement stability, value-based participation, and reporting obligations.
Article Sections
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Payment picture: Past, present, future
This section summarizes the transition away from the prior Medicare payment formula and outlines the broad payment timeline established by new federal legislation. It also places the changes in the context of long-term physician payment predictability.
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Value-based payment binge
This section discusses the broader move toward value-based reimbursement and the role of alternative payment models in Medicare policy. It describes how the legislation frames future incentives for participating practices.
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Reporting program round-up
This section reviews the restructuring of physician quality reporting programs into a single system and notes the related transition period. It focuses on how the consolidated reporting approach fits into the larger payment reform effort.
What You Will Learn
- How Medicare physician payment policy changes after repeal of the SGR formula
- What broad payment-update phases are described in the new legislation
- How value-based reimbursement and alternative payment models are being emphasized
- How major physician reporting programs are being consolidated into one system
- What kinds of practices and professionals should follow these policy changes
Who Should Read This
- Physicians
- Practice administrators
- Medical billing and reimbursement professionals
- Coding compliance staff
- Healthcare policy readers
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