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How to Prepare for Value-Based Reimbursement


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Private insurers, along with the government, are pushing increasingly harder for value-based reimburse­ment (VBR) of providers, leading to a shift away from the traditional physician compensation model toward a new focus on quality outcomes. With VBR becoming less a matter of “if” and more of “when,” savvy physician practices are beginning to familiar­ize themselves with how it works, so they can make the transition more smoothly when the time comes.

BEYOND ACOs: The Patient Protection and Affordable Care Act (PPACA) offers a number of options for providing care and paying providers, including the formation of accountable care organizations (ACOs). The CMS will reward ACOs that reduce costs while meeting performance standards on quality of care.

Provider participation in ACOs is purely voluntary, but, even if you’re not planning to join one, you’re likely to find yourself operating in a new compensation environment in the near future. It’s likely that com­pensation will reflect quality instead of volume, taking into account physician performance metrics such as efficiency, coordinated care, and patient satisfaction.

Beginning in 2015, the health care act now requires the CMS to begin applying a “value-based payment modifier” under the physician fee schedule. Although the modifier will initially apply only to practices with 100 or more eligible professionals (including nurses, physician assistants, and other non-physician staff), it’s scheduled to apply to all physicians and groups by January 1, 2017.

Since the passage of the health care act, several models of value-based reim­bursement have emerged, including pay-for-performance. Under this hybrid model, physicians are paid a negotiated payment for each service, with additional incentives based on costs, quality, and patient experience.

Posted in: ACA