If doctors want to continue providing the best care for their patients, they will need to fight through the challenges of data reporting and government mandates accompanying the transition to value-based care.
The biggest driver of the shift is the Medicare Access and CHIP Reauthorization Act (MACRA), but its data-reporting requirements have many doctors confused and concerned about implementation costs and their effect on practice finances. It’s all part of a broader government-mandated move away from fee-for-service medicine, and that’s not going to change.
“Everything down the road in reimbursement is going to be based on quality and outcomes,” says Joseph Schlecht, DO, a primary care physician in Jenks, Oklahoma, who has been tracking and reporting quality data for more than a decade. Practices cannot be run the way they are now, and if they fail to change, the doctors running them will be looking for a job in five to 10 years, he adds.
While physicians struggle to figure out the next steps for their practices, they need to keep in mind that the shift away from fee-for-service is not just about saving money for Medicare or increasing profits for insurance companies—patients benefit when value-based care is done correctly.
“Putting quality-based protocols in place allows a practice to get better outcomes and achieve better quality, and that’s what payers and the public want for the future,” says Schlecht.
Winning the opening rounds: Study the opponent
For doctors to succeed in this new environment, they will need to understand the challenges of value-based care and embrace them, says Lerla Joseph, MD, a primary care physician in Richmond, Virginia.
Hot topic: The benefits of physicians volunteering
“I think the first step is to understand what [the Centers for Medicare & Medicaid Services (CMS)] is requiring and what other payers are requiring,” says Joseph, who formed an accountable care organization to join forces with other doctors to navigate the challenges of value-based care while maintaining her independence.
Members of the ACO work together to improve quality and help each other work through the best way to comply with
MACRA. “It can seem a bit daunting when you look at all the metrics, but value-based care requires you to look at a population and not just an individual patient,” she adds.
MACRA has two payment options: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Most small practices will participate in MIPS, which calculates payment adjustments (bonuses and penalties) based on evidence-based and practice-specific quality data categories created by CMS.
APMs are payment models developed in partnership between CMS and the clinician community that provides added incentives to provide high-quality and cost-efficient care and may apply to a specific clinical condition, care episode or population.
Schlecht is in the Comprehensive Primary Care Plus program (CPC+), which is a form of a patient-centered medical home that qualifies as an APM. Before that, he was involved in other quality reporting initiatives, including some developed by his staff after he wanted to improve outcomes for his patients with diabetes.
Based on all this experience, he says doctors in MIPS need to know one thing: The only way to be successful in MIPS is to understand registries.
“Development of registries, severity indexing, [higher hepatocellular carcinoma] indexing—all will be critical for them to be successful down the road,” he says. “Identifying every diabetic in a practice and then putting protocols in place like three-month visits, foot exam every visit, eye exam once a year—all those need to be put in place.”
Registries will help a practice identify patients who require additional assistance and highlight where the practice is doing well and where it needs improvement when its numbers are compared to other practices. Both Schlecht and Joseph encourage physicians to check with whatever professional organizations they belong to for help with registries and getting started with value-based care and MIPS. “Look around and see what exists that matches your values and then go for it,” Joseph says.
Winning the middle rounds: Get into the fight
This year, MACRA has a pick-your-pace option, meant to encourage physicians to try the program at their own speed, but some haven’t done anything yet. Experts say it’s not too late to get started.