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An Emerging Values-Based Healthcare Payment Model

5 Responses

1. Ann Miller RN MHA, on November 13, 2012 at 11:10 AM said:

   CMS Details Plans for Implementing a Value-Based Modifier

   CMS has detailed its plans for implementing a value-based modifier required by Congress to adjust physician pay based on the quality and cost of care beginning in 2015. CMS had proposed that physicians practicing in groups of 25 or more health professionals be subject to the modifier. Organized medicine groups, including the AMA and AAFP, advocated for raising the threshold, and the agency agreed to increase it to groups with 100 or more health professionals.

   Any eligible physician who does not report physician quality reporting system measures in 2013 stands to have his or her pay reduced by 1.5% in 2015. A physician practicing in a larger group who does not report PQRS measures could have 2015 pay reduced an extra 1% by the modifier. Successful PQRS reporters in larger groups will be spared from an automatic modifier reduction, but they also can choose to have the modifier apply. That choice carries the risk of a modifier reduction but could result in higher pay for participants that better control Medicare spending and boost quality relative to their peers.

   Source: Charles Fiegl, Amednews [11/12/12]

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2. Charles, on December 3, 2013 at 4:37 PM said:

   Payment under value-based purchasing programs

   Medicare payments cut for more than 1,400 hospitals under value-based purchasing program.

   http://www.modernhealthcare.com/article/20131115/NEWS/311159950?AllowView=VDl3UXpKSzRDL0dCbkJiYkY0M3hla0tvaWtVZEQrWT0=&utm_source=link-20131115-NEWS-311159950&utm_medium=email&utm_campaign=mostreq#

   Yep – More than 1,400 hospitals will see their Medicare payments docked in 2014 as a result of their performance under the CMS’ value-based purchasing program, according to newly released federal data.

   Any thoughts?

   Charles

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3. Dr. David Edward Marcinko MBA, on October 7, 2014 at 3:40 PM said:

   Valuing Physician Work in Medicare
   [Time for a Change]

   The Relative Value Scale Update Committee (RUC)—a small panel of medical professionals whose recommendations have considerable influence over Medicare payment levels for their own services—has drawn quite of bit of political and media scrutiny recently.

   Some noted concerns include the RUC’s underrepresentation of primary care, restricted access to its deliberations and the potential for professional interests to skew the outcomes.

   Any more thoughts?

   Dr. David Edward Marcinko MBA

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4. Henry Loubet, on February 27, 2015 at 7:00 PM said:

   Value Based Purchasing

   The federal government has a considerable base of Medicare participants and the ability to impose requirements through the legislative and regulatory process. Simultaneously, the private sector faces issues of fragmentation and lack of alignment toward the goal of value based purchasing in health care.

   However, employers are in a position to make progress if they are able to find resources and the unity to do it. The history of health cost containment has often involved initiatives that gain savings for one segment at the expense of another. Value Based Purchasing (VBP) will require a shift in this type of thinking and the objectives that shared value is a win-win for everyone. Harvard School of Business Professor and author Michael E. Porter has stated the case well:

   “As major purchasers of health care services, employers have the clout to insist on change. Unfortunately, they have also been part of the problem. In buying health care services, companies have forgotten some basic lessons about how competition works and how to buy intelligently.”
   – Michael E. Porter

   Overcoming the issues and challenges of VBP on the private employer side will involve a number of basic changes to the current system of health care financing and delivery:

   * Employers will need to be part of a large enough core of stakeholders to achieve influence with providers in transparency, payment incentives and improvement goals. This may include participation in a business coalition or under a program operated by the health plan they contract with.

   * Employers will need to have a high level of engagement and investment into VBP to receive significant returns. This means they will need to demonstrate upfront leadership in promoting the VBP initiative and encouraging their peer organizations to participate in the concept of a shared value benefit.

   * Agreement on metrics to evaluate outcomes and payments/penalties and the ability of those metrics to support continuous improvement over time.

   * Access to and consistency of Health IT capabilities for evaluating measurement data that is clear and quantifiable.

   * Robust electronic health record system, accessible to providers uniformly in real time, to avoid duplication of services, tests, etc. Integrated organizations such as Kaiser are better able to achieve this capability.

   * Both the data analysis and health care delivery technology will likely need some private sector investment for the true long-term savings to materialize.

   Keenan is most supportive of Value Based Purchasing and its attributes in reducing costs, increasing members and employer engagement, advancing consumerism and improving quality. The potential of the VBP model to move health care to a more sustainable condition makes the effort and investment worthwhile. We need to come to greater agreement on the means for achieving these goals but great strides have been made so far.

   Henry Loubet
   [Chief Strategy Officer]
   Keenan

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5. Ann Miller RN MHA, on May 11, 2015 at 6:40 PM said:

   Healthcare CEO Attitudes Toward Value-Based Care

   Modern Healthcare’s first quarterly CEO Power Panel survey reveals the opinions of 55 CEOs regarding reimbursement models. Here are some key findings from the report:

   • 78% of respondents support moves toward value-based reimbursement models
   • One-fifth said that fee-for-service should end entirely
   • 2% believe FFS medicine should continue to play the dominant role in healthcare reimbursement
   • One-third of respondents said value-based reimbursement models will shrink their margins
   • 27% believe value-based reimbursement will shrink their top-line revenue

   Source: Modern Healthcare, May 4, 2015

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