In 2018, Deirdre Baggot, an expert on bundle payments, believed that the Centers for Medicare and Medicaid will start a new Alternative Payment Model.

Baggot thought it was one of 2018’s biggest events in payments that are value-based. In the 18 months, there has been ambiguity about the value agenda. She thinks that it would be important to remember that Medicare Acess and CHIP Re-authorization Act (MACRA of 2015 passed overwhelming in the Congress of the United States.

What did MACRA do? It repeated the Growth Rate formula, changed the way the rewards that clinicians get from Medicare, made many quality programs simpler under the Merit Based Incentive Payments System (MIPS) and gave financial incentives to participants in alternative payment models.

An APM or Alternative Payment Models are determined by MACRA. MACRA says that APMs make tit possible for physicians to get 5% Part B bonus payments from 2019 to 2024. After 2026, these physicians will get .75% fee-for-service (FFS). Read full interview of Deirdre Baggot at Inspirery

When it comes to bundled payments, a payer is expected to get a fixed amount of money for medical services and care that they get over a fixed amount of time. Doctors, hospitals, and post-acute providers will get bonuses if they are able to give care that cheaper than the price that was determined in the past.These people will not get bonuses if they give care that is more than the bundled price.

A payer can qualify for Bundled Payments for Care Improvement-Advanced Initiative (BPCIA). They have made payments that are based on MIPS. The participants in the MIPS program are facing a certain amount of financial risk. In this program, payments are based on performance and quality. This program also included 3 outpatient episodes and 29 impatient episodes. An episode is defined as being 90 days in length.

Deirdre Baggot is the one to ask if a person wants to know about medical insurance programs.

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