Dr. Dowling is the Vice President of Medical Affairs and Policy for IntrinsiQ Specialty Solutions (an AmerisourceBergen Specialty Group company), a board-certified Clinical Informaticist, and the former medical director of a large metropolitan urology practice. He resides in Ft. Worth, Texas.
Value-based payment models tend to fall into three general categories: shared savings programs, capitation models, and episode-of-care models. In this article, Robert A. Dowling, MD, reviews the current landscape of these payment models, including public and private-sector models that may serve as examples for urology.
Each year, the Office of the Inspector General at the Department of Health and Human Services publishes a summary of its activities and a work plan for the coming year. What follows is a summary of new topics in the FY2017 work plan that may be of interest to urologists.
The Centers for Medicare & Medicaid Services (CMS) recently released the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for 2014 claims. Part of a broader effort to increase transparency about care in general, this dataset also gives very granular information about the prescribing patterns of providers and may be used by policy makers to further scrutinize the cost of prescription drugs in the United States.
In this installment in a series on MACRA, I will review the definition of APMs, how participating providers would be reimbursed under MACRA (as proposed), and the relevance to specialists, including urologists.