Guest post by Alok Prasad, CEO, RevenueXL.
Though many Medicare and private payer reimbursement programs that require practices to begin moving to value-based compensation already have set sail, most small practices are still treading water near the shore when it comes to this new wave of payment models.
While admirable in their care goals, these quality care-based reimbursement programs can pose some insurmountable challenges for small providers. In fact, they require a whole new way of providing care for some practices, as well as creating new documentation of integrated data analysis, development of care coordination with other providers, payer reporting applications, and often times new technologies that can support these new provisions.
What’s more, all this change also can be quite expensive for small practices and wreak havoc on current business practices.
Set the course
No doubt about it, though, the move to value-based care is on. According to the 2015 Physician Compensation Survey, conducted by Physicians Practice magazine, 63 percent of physician compensation is currently tied to productivity; 37 percent to value metrics and 29 percent to patient satisfaction scores.
The Centers for Medicare and Medicaid Services (CMS), however, has expressed its goals of having more providers participating in value-based plans each year, with a goal of 50 percent by 2018. And it has further incentivized physician participation by specifying increasing reductions in payments for non-participation that began in 2013.
So unless they want to start leaving money on the table, practices have no choice but to take the plunge into such new compensation programs.
Lift the Anchor
Before diving in and potentially draining money and resources to participate in such programs, physicians need to look around and assess their current situation to determine how the new reimbursement model might work in their practice. For example, they need to evaluate current technology, vendors, resources and physician support to determine what changes they need to make, as well as what internal infrastructure they can use.
Then they should compile a list of quality reporting or performance metrics that make sense for their practice to track and get a consensus among staff that they are indeed the goals of where the practice wants to go with care quality. For example, some general care quality goals could be related to population health or chronic care management.
Get a Life Preserver
Once you have your quality care metrics, start ensuring that your current resources can handle them. For example, you might want to ensure that you have functionality in your electronic health record that can support the new care model. To ensure that this is the case, you should determine if your EHR can:
- Accommodate new parameters that enable you to seamlessly track the data?
- Provide caregivers with the ability to view results to build on their patient care?
- Make it possible to report quality measures easily and completely?3
- Enable clinicians to access patient data and evidence-based treatment guidelines to make informed decisions?
- Support the use of population health management and registry tools to address high priority patients?
In addition, it might also behoove small practices to partner with large groups or other organizations to share resources to accomplish their care reporting goals.
Some larger organizations, including local accountable care organizations, patient-centered medical homes or national industry groups including the American Medical Association and the Medical Group Management Association, already have developed resources that smaller groups could subscribe to in order to help facilitate their value-based care reimbursement goals. Some of these shared resources include fully-developed patient satisfaction surveys, value-measures, reporting analysis and other best practice research.
Be Wary of Storms
Small practices, however, should keep their eyes open to the challenges of using already established groups to help facilitate their value-based reimbursement goals. For example, there sometimes is a hefty cost, both financially and resource-wise, associated with joining such groups. They also may not be as ready as they lead on to be to offering a singular, proven, automated method to collecting and reporting such data.
An October 2014 report shows that though various IT, including interoperable EHRs, population health management applications and registry software, are crucial to successful value-based payment programs, myriad interoperability issues persist among ACOs and other similar groups which has led to:
- Few ACO participants having access to reliable claims data;
- Inconsistencies caused by different methods of using quality measures resulting in extra manual work for providers;
- And providers having trouble with extracting consistent clinical quality data from EHRs to create value-based care reimbursement reports.