Key CMS Value-Driven Healthcare programs now underway are:
- Identifying and promoting the use of quality measures through pay-for-reporting: Physicians, Hospitals, and Home Health Pay-for-Reporting (commonly called PQRI).
- Paying for quality performance: hospital pay-for-performance: premier demonstration.
- Developing and using measures of physician and provider resource use: Internal Workgroup to Develop Resource Use Measures, Medicare Improvements for Patients and Providers Act Implementation.
- Paying for value: promoting efficiency in resource use while providing high quality care: Hospital-Acquired Conditions (HACs) and Present on Admission (POA) Indicator Reporting, Hospital Value-Based Pricing (VBP) Plan Development, Physician VBP Plan Development, Payment for End-Stage Renal Disease Patients, Physician: Physician Group Practice Demonstration, Home Health Pay-for-Performance Demonstration, Nursing Home VBP Demonstration, Medical Home Demonstration.
- Promoting better alignment of financial incentives among providers: Proposed Exception to the Physician Self-Referral Rules, Medicare Hospital Gain-Sharing Demonstration, Physician Hospital Collaboration Demonstration, Acute Care Episode (ACE) Demonstration, Post Acute Care (PAC) Payment Reform Demonstration.
- Fostering transparency and public reporting: Compare Site Reporting Upgrades/Star Rating Systems, Charted Value Exchanges (CVE): Communities Designated by the Department of Health and Human Services as Working to Improve Quality and Value of Healthcare.
- Implementing and Adopting EHRs and health IT: E-Prescribing Incentive Program, Electronic Health Record Demonstration, Personal Health Record Choice Pilot.
For a more detailed look at each of these programs, visit www.rheumatology.org/practice.
Are You Ready for Value-Driven Healthcare?
There are several ways that you can get your practice in order and aligned with those goals of value-based purchasing. Of utmost importance is committing to monitoring your practice’s macro environment to identify value-driven healthcare related plans and pilot programs. A variety of new programs and contracting terms are likely to present over the next few years (if not months), and each will offer a bevy of potential opportunities, challenges, and other implications. Identifying these and strategically planning for what is in your practice’s best interest will help to position your organization for success.
It is likely that your practice already engages in value-driven healthcare-related programs with various health plans. Do you know what quality measures you are reporting and to whom? Take note of these, and identify the processes that you have in place to track, monitor, and report measures accurately and efficiently.
You should also be keeping track of what payment programs and contracting alternatives are being proposed by CMS and private payers. Discuss the financial and workflow implications of these payment structures with key clinical and administrative staff. Identify those programs that could potentially benefit your practice, and be sure that you completely understand the eligibility and resource requirements for participation. If revenues are expected to change as a result of the program, identify appropriate actions to be taken and set key thresholds and break-even points.
