Quality Performance and Compensation Considerations

Abstract

Traditionally, physician medical services, including surgical pathology and cytopathology, are compensated based on the type and amount of service provided. However, government payment for physician services is shifting toward value-based payment where the amount of compensation for a service is based in part on the quality of service provided in addition to the type and amount of service provided. Pathologists have been leaders in developing quality programs to improve medical care through our initiation of laboratory accreditation and proficiency testing programs. Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), payment for physician services may be positively or negatively adjusted based on the clinician’s performance in four distinct categories: quality, cost, promoting interoperability, and improvement activities. As an alternative, physicians may participate in advanced alternative payment models (APMs) and also have their reimbursement adjusted based on quality and cost. Qualified clinical data registries allow for a unique way to participate in the MIPS program. Developing meaningful performance metrics for pathologists to utilize in these quality payment programs is challenging given the ever-changing regulatory and practice environment.