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Welcome to MedChi, The Maryland State Medical Society.  
As the statewide professional association for licensed 
physicians, we are dedicated to our mission to serve as 
Maryland's foremost advocate and resource for physicians, 
their patients, and 
public health.

Thursday, May 23, 2024
You are here : Your Profession  >  Center for the Private Practice of Medicine  >  Total Cost of Care
Total Cost of Care


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An Overview of Maryland's Unique All Payor Contract and Rate Setting - By: Gene Ransom (2021)

Click here to view the overview.

Healthcare Payment Glossary
The Healthcare Payment Glossary is intended to facilitate a better understanding of the terminology used in healthcare payment systems and to create a foundation for all stakeholders — patients, providers, employers, health plans, and government agencies — to reach consensus on how to reform healthcare payment.

Medicare Access and Summary CHIP Reauthorization Act of 2015 (MACRA)
Legislation that repealed the Sustainable Growth Rate formula and replaced it with the “Quality Payment Program."  This proposed rule requires physicians to participate in either the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs).

Summary of 2022 Maryland Value-Based Care Legislation
This legislation contains the strongest protections for the physician community for those physicians that chose to enter into these arrangements and for those that want to remain fee-for-service, including a provision that states that a carrier may not reduce the fee schedule of a physician who remains fee-for-service and does not participate in a two-sided incentive arrangement.  Click here for a chart illustrating the bill has initially put forth in December 2020 and the bill as passed by the committees.  It is anticipated that the legislation will move through the full General Assembly and that the Governor will sign it.

An episode-based payment program for non-hospital providers designed to: 

  • Help the State meet the financial targets of Total Cost of Care (TCOC) Model
  • Include more providers in a value-based payment framework (that is, to have responsibility and share in rewards for reducing Medicare TCOC spending)
  • Encourage multi-payer alignment in a value-based payment framework
  • Include more episodes than in Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) models
  • Broaden access to Medicare’s 5% Advanced APM (AAPM) MACRA opportunity