What will the new payment system look like for emergency physicians? Much remains to be sorted out in the coming years, but several aspects are clear and written into law. Physicians payments will follow the new Merit-based Incentive Payment System (MIPS), which replaces three previous physician payment programs into one that ties a bonus or penalty each year to physician performance on 4 key areas of clinical transformation: quality, cost efficiency, use of electronic health records and practice improvement activities. (Figure 1) Unlike the Physician Quality Reporting System (PQRS) program that over 60% of emergency physicians participated in last year—MIPS is mandatory for nearly all physicians and raises the stakes from 1–2% of payments per year to a +/- 9% payment adjustment by 2022. Unlike older programs, the MIPS allows eligible clinicians (emergency physicians or advanced practice providers such as PA and APRNS) to report as an individual or as a group (defined by Tax Identification Number [TIN]), thereby enabling quality measures to better match the team-based care models in emergency medicine.
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