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Arrhythmia care in a value-based environment: Past, present, and future

Developed and endorsed by the Heart Rhythm Society (HRS)
Published:December 15, 2017DOI:https://doi.org/10.1016/j.hrthm.2017.10.041
      The Medicare Access and CHIP Reauthorization Act (MACRA), passed by Congress in 2015, establishes the Quality Payment Program (QPP), which represents a significant change in how physicians are paid by the Centers for Medicare and Medicaid Services (CMS). Since the introduction of Medicare, there have been concerns about financial sustainability. In 1997, the Sustainable Growth Rate (SGR) formula was established to match physician expenditures to economic growth.

      Estimated Sustainable Growth Rate and Conversion Factor, for Medicare Payments to Physicians in 2015. Centers for Medicare and Medicaid Services. https://www.cms.gov/medicare/medicare-fee-for-service-payment/sustainablegratesconfact/downloads/sgr2015p.pdf. Published April 2014. Accessed December 4 2017.

      Under the SGR law, if total expenditures exceeded the calculated SGR, reductions in physician payment would be triggered. Congress repeatedly legislated alternatives to payment reductions to avoid the potential for decreased access to care for patients covered by Medicare, but this created uncertainty within the health care system. MACRA eliminates the SGR, which is a reason why it received broad support in the medical community.

      Madara JL. American Medical Association. SGR Letter to Senate. https://searchlf.ama-assn.org/letter/documentDownload?uri=/unstructured/binary/letter/LETTERS/sgr-senate-letter-13april2015.pdf. Published April 13 2015. Accessed December 4 2017.

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      References

      1. MACRA. Centers for Medicare and Medicaid Services. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/macra-mips-and-apms/macra-mips-and-apms.html. Updated November 2017. Accessed December 4 2017.

      2. Estimated Sustainable Growth Rate and Conversion Factor, for Medicare Payments to Physicians in 2015. Centers for Medicare and Medicaid Services. https://www.cms.gov/medicare/medicare-fee-for-service-payment/sustainablegratesconfact/downloads/sgr2015p.pdf. Published April 2014. Accessed December 4 2017.

      3. Madara JL. American Medical Association. SGR Letter to Senate. https://searchlf.ama-assn.org/letter/documentDownload?uri=/unstructured/binary/letter/LETTERS/sgr-senate-letter-13april2015.pdf. Published April 13 2015. Accessed December 4 2017.

      4. Shinkman R. NEJM Catalyst. Physician Frustration and Fear of MACRA. http://catalyst.nejm.org/physician-frustration-fear-macra/. Published August 4 2016. Accessed December 4 2017.

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