AMDA's 2019 Annual Conference

TH9 - Alphabet Anarchy—Impact of MIPS, MACRA, APMs, VBP, and PDPM on PALTC Physicians

Mar 7, 2019 1:30pm ‐ Mar 7, 2019 5:00pm


Payment reform is affecting physicians and facilities alike in PALTC. The role of PALTC physicians and medical directors is evolving and now requires a high level of understanding of Alternative Payment Models (APMs), the Merit-based Incentive Payment System (MIPS), the Medicare Access and CHIP Reauthorization Act (MACRA), Value- Based Purchasing (VBP), and Patient-Driven Payment Models (PDPM). It is imperative that physicians align their goals with PALTC facilities and achieve optimal outcomes for their patients while ensuring that they qualify for available payment incentives and avoid penalties. With its scheduled implementation of October 1, 2019, PDPM is the single most significant change to SNF reimbursement in nearly 20 years. Finally, avoidable readmissions of Medicare A beneficiaries has emerged as the singular indicator of unnecessary and wasteful spending of health care resources and bad outcomes. This metric defines the “Value” in Value-Based Purchasing by affecting both quality of care received by beneficiaries and the cost. This session will feature interactive clinical scenarios and two pilots designed to reduce readmissions in SNF populations. One is a Missouri Quality Initiative (MOQI) that is part of a Center for Medicare and Medicaid Innovation (CMMI) grant. The second is a Chicago-area study of six nursing homes where implementing best practices and measuring clinician compliance resulted in reducing readmissions by 25% in three months.

Learning Objectives: 

  • Review various programs that are part of payment reform—including MIPS/MACRA, APMs, VBP, and ACOs.
  • Describe how PDPM will work and how it will potentially impact MDS, ICD 10, documentation, and overall care.
  • Explain the interplay of quality and cost in defining value and better outcomes.
  • Discuss possibilities of creating advanced APMs for PALTC practitioners using best practices.


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