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With 2017 quickly approaching, the topic all DCs should be paying attention to is value-based healthcare and the changes it will bring to the profession.
Here are the most common questions about value-based healthcare and how DCs can start making changes now.
1. How will Alternative Payment Models (APMs) and Merit-based Incentive Payment System (MIPS) change healthcare?
The Medicare program has been attempting to move from a fee- for-service, pay-for-volume system to a “pay for value” system for the last several years. Initial efforts focused on “carrots” or financial incentives for healthcare professionals to adopt electronic health record (EHR) software systems and report quality results. However, in the last couple of years, those programs, such as meaningful use and PQRS, have morphed into penalty programs. A new bonus and penalty program, which added cost-effectiveness to the mix, the Value-Based Modifier (VM) program, has also been added.
MIPS increases the stakes. The new MIPS program will consolidate all three programs into a single program with four performance categories— quality, advancing care information, clinical practice improvement, and resource use. Commencing with the 2017 performance year, MIPS will increase the stakes, and then in 2019, 2017 MIPS performance will be translated into a Medicare payment rate.
For each of the next several years, potential MIPS penalties and bonuses will both increase. During this entire period, the base Medicare fee schedule will be frozen, and complete MIPS results will be publicized on Medicare’s Physician Compare website, visible to all patients and payers. Thus, for many healthcare professionals, successful MIPS performance will be critical to the economic viability of their practices.
The APM option. Medicare has provided an alternative to MIPS: participation in an “Advanced Alternative Payment Model.” Healthcare professionals who participate in Advanced APMs have the potential not only for bonuses but also for downside financial risk. Together,
APMs and MIPS will likely force DCs to fully embrace health information technology and data analytics, to more aggressively adopt and implement best practices, and migrate to clinically—if not financially—integrated systems where they can better manage the health of patient populations.
2. Why are these changes occurring in healthcare?
APMs and MIPS were the direct result of the passage of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. The fundamental reason for the shift to value-based payment systems is the payers’ belief the U.S. spends far more on healthcare than other industrial nations without achieving offsetting benefits, making it increasingly hard for U.S. companies to compete in the global marketplace.
3. Are providers prepared for these changes?
While the transition to value- based payment does require a dramatic shift in thinking and the implementation of new technologies and practice patterns, it is not rocket science. Moreover, shifting efforts away from maximizing the number of services to ensuring patients instead get the right care at the right time is perfectly aligned with chiropractors’ ethics and professional aspirations. Assuming new payment models will indeed reward DCs for engaging in the necessary planning, outreach, and care coordination activities that were never compensated in the past, the move to value-based payment will be a win for patients and the providers who care for them.
4. How can DCs prepare to be a part of the changes?
Here are some steps to take now to achieve the practice redesign and transformation necessary for success:
Evaluate your current patient population.
In order to optimize the care your patients receive, you need to understand them as a group as well as individuals. Generally speaking, there will be relatively few diagnoses and relatively few services that account for the bulk of your practice, and relatively few truly high-risk patients. By knowing that information, you can focus your care coordination efforts where they will make the most difference.
Select some appropriate evidenced-based clinical guidelines and quality measures.
Once you know the treatment areas of most importance to your practice, pick relevant clinical guidelines for implementation.
Measure your results and implement changes as warranted.
Value-based payment is based on your results, not on how many services you provide. Take the steps necessary to ensure your patients are doing as well or better than those of your peers.
Implement a robust HIT system. All value-based payment systems will require you to report on your outcomes and communicate electronically with your patients.
5. Why is data so important to the future of the profession?
“Value based healthcare is all about achieving better outcomes, lower cost, and higher levels of patient satisfaction. All of these things have data attached to them,” says Jay Greenstein, DC, CEO of Sport and Spine Rehab. “These points will be used to show how they add value to the system and also how we as a profession collectively aggregate that information and demonstrate to the payers how we provide more value to the system. Data makes it very clear to someone who is paying our bills that we are way more cost effective, we get better outcomes, and our patients are more satisfied, and therefore benefits should be designed to send a certain population to a chiropractor first. That is not an opinion if it comes from analytics.”
6. What types of data will start to be crucially important with these changes?
You need to know what your patient population looks like as a whole, so you can eliminate gaps in care and provide extra support for those who face significant health challenges. You need to know what percentage of the time you adhere to best practices and your patients are compliant. You need to know what your patients and your referring providers think about you.
7. What are some dates and deadlines that providers need to start paying attention to?
Although MIPS will not affect your Medicare payments until 2019, that impact will be based on your performance commencing January 1, 2017.
Catherine Hanson is one of the founding partners of QVH Systems LLC. Considered one of the nation’s premier experts in healthcare law, she has provided advice and counsel to physicians, medical associations, and other healthcare-related organizations throughout her 30-year career.
Casey Nighbor is the associate editor of Chiropractic Economics. She can be reached at cnighbor@chiro.com, 904-395- 3389, or through ChiroEco.com.
