Accountable Care Organizations: Understanding the New Frontier of Physician Payment-ACOs and Medicare

Video Transcription

Video Summary

The video discusses Medicare's push for alternative payment models (APMs) and value-based care. Medicare aims to have everyone in a traditional Medicare plan be part of an accountable care organization (ACO) relationship by 2030. APMs include ACOs, bundled payment models, and disease-based payment models. Providers in APMs are excluded from participating in the Merit-Based Incentive Payments (MIPS) program. Medicare has already shifted significantly away from fee-for-service payments, with most payments being tied to quality metrics. Becoming a qualifying participant in an APM requires meeting certain criteria, such as receiving a percentage of Medicare payments or treating a percentage of Medicare patients through an APM. Qualified participants receive bonuses and incentives. However, the model presents challenges for interventional cardiologists, and there is a trend towards consolidation and employment models for specialists. The pathway to becoming a qualifying provider is difficult for interventional cardiologists, as they would need to be employed by a large accountable care organization. The decrease in payments to physicians is not fully offset by the bonuses for qualifying participants. This poses challenges and discouragement for specialists.

Asset Subtitle

Colin M. Barker, MD, FSCAI

Keywords

Medicare

alternative payment models

value-based care

accountable care organization

APMs