The organizations who will likely thrive as health care shifts to fee-for-value payments are those who aggressively embrace the changes.
Both the Centers for Medicare and Medicaid Services (CMS) and Congress have sent strong indications recently that the primary engine for future health care reforms will be quality rather than quantity. And based on the GOP’s past history of support for fee-for-value, a Republican-controlled Congress is unlikely to change that dynamic.
To encourage participation in their value-based purchasing programs, Medicare policies are steadily incentivizing value and penalizing fee-for-service.
The most recent Medicare Shared Savings Program (SSP) proposed rule, published in December 2014, recommends modification to the payment track model (including an additional track), waivers to support medical management and patient engagement, data sharing requirements and beneficiary assignment. This rule addresses some issues providers had with the SSP, and should encourage more organizations to participate.
Another relatively new rule, the Medicare Physician Fee Schedule (PFS) Final Rule formalized the value-based modifier for all physicians participating in Medicare’s fee-for-service program. Published in October 2014, the rule finalizes a modifier rewards high-performing physicians and penalizes poor performers. In other words, every physician participating in Medicare now has a portion of his or her income at-risk based on quality performance.
Considering the writing on the wall, health care organizations can position themselves for the future when they recognize that CMS wants participation in their programs. In many cases, CMS will actually compensate physicians simply for participating.
Organizations just implementing value-based care initiatives will want to monitor their effectiveness by using regional and national averages as benchmarks. Doing so will also highlight opportunities for growth and improvement.
Along with adapting to changes in the Medicare quality measures and reimbursements, it’s wise for organizations to evaluate current policy for the Medicare Shared Savings Plan in light of proposed SSP rule changes.
To get more detail about federal support for value-based care, download a copy of Optum’s Trend Watch.