Overview, Impact & Strategic Considerations of the Quality Payment Program

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.