7. The rapidly changing reimbursement landscape
After years of discussion, the shift from rewarding volume to value took formative steps this year, but there is uncertainty that it is moving at the pace set by federal officials.
In 2015, the U.S. Department of Health and Human Services (HHS), announced that it would tie 30% of all Medicare fee-for-service payments to quality or value through alternative payment models (APMs) by 2016 and 50% by 2018. These APMs include accountable care organizations and bundled payment arrangements among physicians.
Furthermore, HHS said it would tie 85% of all Medicare fee-for-service payments to quality or value by 2016 and 90% by 2018. A Centers for Medicare & Medicaid Services (CMS) spokesperson told Medical Economics via email it could tie 31.2% of fee-for-service payments to APMs in 2016 based on reconciled claims data. This result would be updated with quarterly data from 2016 as part of the next CMS budget in 2019, the spokesperson said, so it will still not have final data for some time.
Regarding the 85% projection, however, CMS says it would not comment on that goal at this time.
The spokesperson says that under a value-based system it is not CMS who should define value.
“CMS should equip patients with the information they need so they can choose the providers that they feel deliver high value,” the email states. “Patients must have the tools and incentives to seek value and quality as they shop for services—the competitive pressure that results will drive the system towards efficiency.”
The statement also says that “getting the move to value-based care right” requires giving clinicians flexibility on process and then holding them accountable for a small set of meaningful outcome measures. This ties to CMS’ recent “meaningful measures” initiative, its pledge to physicians to streamline quality measures and reduce regulatory burden.
CMS says the new approach to quality measurement will assess only core challenges to providing high-quality care and improving patient outcomes. It will achieve this primarily through a re-focused CMS Innovation Center, which will lead efforts to promote greater flexibility and patient engagement.
To keep up with the latest changes in physician reimbursement, visit bit.ly/18-reimbursement