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Alternative Payment Models to Affect Otolaryngologists

Reimbursement has entered a new era with the advent of the Medicare Access & CHIP Reauthorization Act (MACRA) that has led to the development of new payment models.

“If you get part of your income from the government, you will want to understand how your payment methodology is going to change under the alternative payment methodology of MACRA,” said Robert Lorenz, MD, MBA, session moderator. “The deadline is 2017 for the alternative payment models to come forward.”

When MACRA legislation did away with the sustainable growth rate formula, it shifted efforts to tie government reimbursement to “value measurement” through either the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). Physicians with a sufficient patient volume can opt out of MIPS and participate in an APM, said Dr. Lorenz, AAO-HNS coordinator of practice affairs and co-chair of the Physician Payment Policy (3P) Workgroup.

The three main options for APMs are patient-centered medical homes, accountable care organizations, and bundled payment systems. Otolaryngologists are most likely to participate in bundled payment systems, which will be reviewed by the speakers during Wednesday’s Miniseminar.

“While bundled payment seems like the most practical way for otolaryngologists to participate in alternative models,” Dr. Lorenz said, “bundles are also challenging within otolaryngology because of the variety of services we offer.

“Secondly, we have limited high-priced inpatient-based diseases through which performance improvement can have a significant savings within a bundled payment system. Most of the fees we collect from Medicare involve outpatient procedures and E&M codes.”

Randal S. Weber, MD, professor and chairman of the Department of Head and Neck Surgery at the University of Texas MD Anderson Cancer Center, Houston, and a speaker at the session will focus on how bundled payment systems work, and describe a unique bundle his department has pioneered in the commercial market.

Another way to link reimbursement to quality is through clinically integrated networks (CINs). In his presentation, Stephen P. Cragle, MD, St. Cloud Ear, Nose, and Throat Clinic, St. Cloud, MN, will discuss how accountable care organizations are related to CINs.

AAO-HNS is working with the American College of Surgeons to identify bundled methodology within three diseases processes—endoscopic sinus surgery, thyroidectomy, and parathyroidectomy.

“Change is upon us, and things will start to move rapidly to meet the regulatory timelines,” Dr. Lorenz said. “The Academy is spearheading otolaryngology’s response to the MACRA legislation that was passed in 2015, so otolaryngologists need to hear what options are available to them to participate in these models.”

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