September 25, 2013

The Road to Value-Based Purchasing in Healthcare is Emerging

Filed under: Uncategorized — HankMayers @ 3:35 pm

In my conversations with practitioners and administrators, one common refrain is serious doubt that the change from fee for service (FFS) to value-based purchasing (VBP) can be achieved. Indeed, I have to acknowledge that I have seen many a good big idea get lost in the details. And make no mistake; This is a VERY big idea.

Fundamentally, the current quality reporting/incentive programs must ultimately morph into vehicles that can enable VBP. And one of our practical problems is that there are quite a few different quality reporting programs at the federal level, and others within the private payer realm, that must come together, or at least be similar enough to avoid unacceptable increases in administrative burden and related cost increases.

After listening to a CMS information session on the Value-Based Payment Modifier (VBPM) program yesterday, I can say that significant progress is being made. Furthermore, I can add that the VBPM is a logically-incremental program designed to move us down the road.

Key themes undergirding the VBPM program include:
…….Based on existing NQF quality measures (process and outcomes)
……….Special subset of 17 measures are available from the following domains, consistent with current national quality goals:
…………clinical care
…………patient experience
…………population/community health
…………patient safety
…………care coordination
…….Cost measures focus on (1) COPD, (2) heart failure, (3) CAD, and (4) diabetes
…….Various existing electronic reporting methods for quality measures all remain valid, including the EHR Incentive and the PQRS Incentive
…….The VBPM program factors for the complexity or clinical risk levels of the mix of the practitioner’s Medicare patients (a very important achievement)
…….A single reporting method for physician groups that elect this option
…….Can satisfy CMS requirement for quality reporting to avoid the start of penalties in 2015 for non-reporters
…….Successful VBPM reporters not only avoid the 2015 penalties, but may qualify for incentive payment premiums (up to 2%) if their quality and cost performance exceed the national mean for similar care and circumstances
………..If enrolled for the incentive, practitioners are also accepting the potential of a deduction (“shared savings/risk”) of up to -1% if their performance is well below the national mean for similar care and circumstances
…….There are a variety of detailed claims and patient reports that a practitioner can use to see how CMS arrived at the scores that a provider has/will achieve

Another part of the VBPM program is that it provides reports with analyses for current FFS practitioners, that are in groups (a TIN registered with CMS) of 25 or more physicians, which they can examine to see, from current claims data, how they might fare if they were to enroll in the VBPM and elected for the incentive payment. This is very helpful, and is the result of a lot input from physician groups.

This is a critical but complex topic, and I encourage my readers to go to the following CMS website to get more information.

This is a very important topic that all of us need to (1) understand at a basic level, and (2) monitor as we go down this road, as it surely will evolve.

Powered by WordPress