Why is it that just when we get used to evidence-based care, we now have to do value-based care? I find evidence-based care for common neurological disorders, such as epilepsy and dementia, valuable. Guidelines provide a framework and act as a reminder to maintain good quality.

But now, there is money on the table. The Medicare Access and CHIP Reauthorization Act (MACRA) was passed by Congress last year. When it comes into play, probably in 2017, physicians must choose between a Merit-Based Incentive Payment System or an Alternative Payment Model. The APM is broadly similar to the old concept of IPAs and capitation. None of us looks back at those years fondly, and this new payment model may prove to be a disaster for neurologists and their patients. Specialists will most likely participate in MIPS and not APM. There is a fixed pool of money in MIPS, so there will be winners and losers.

The American Academy of Neurology admirably has developed a “Payment Alternatives Team” and is partnering with its members to establish appropriate care for headaches and epilepsy, which I assume will be loosely based upon evidence-based guidelines.

We should applaud the AAN. For neurologists in private practice, this is truly a brave new world.

See Neurology Today, June 25, 2016, page 30.

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