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Overview, Impact & Strategic Considerations of the Quality Payment Program

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March 31st, 2017

In April 2015, Congress enacted a law that alters the
method by which physicians and other health care providers
are paid for Medicare Part B services. The Medicare Access
and CHIP Reauthorization Act of 2015 (MACRA) replaced
the sustainable growth rate formula with physician
payments tied to quality. Providers must choose either
significant performance-based payments tied to fee-for-service
or accept population-level risk. The direct impact on
physicians and the delivery system may ultimately be greater
than that of the Affordable Care Act. The law will cause
physicians to alter the way they deliver care and shift their
focus toward value-based outcomes and population health
management. New payment incentives will lead to provider
organization reconfiguration including consolidation, novel
partnership models, and the creation of new risk-bearing
entities. Although program refinement will continue to
occur, it is critical for providers to expeditiously evaluate
their organizational capabilities, determine the appropriate
payment model to pursue, and gain the necessary resources
and experience to be prepared for successful participation.

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