The healthcare payment reform movement has brought both advantages and challenges to the industry. Of course, pay-for-value models give patients the benefit of efficient and quality care. Meanwhile, medical facilities must adapt to compensation changes, which require adjustments of healthcare information technology systems.
Specifically, the U.S. Centers for Medicare & Medicaid Services aims to tie 30 percent of payments to value through alternative payment models by the end of this year. By 2018, the CMS plans to boost that figure to 50 percent.
Two representatives from CMS discussed the organization’s goals for achieving these outcomes at the 2016 State Healthcare IT Connect Summit.
Medicare Access & CHIP Reauthorization Act of 2015
Rob Anthony, acting group director of the quality measurement incentive value group of the CMS, noted that quality has become a focal point in healthcare in the last decade, partially due to the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). The legislation, which replaced the Sustainable Growth Rate formula and serves as the new model for establishing Medicare payments for healthcare services, allows physicians to demonstrate payment value. MACRA also works to reduce the burden of reporting by consolidating existing programs into a single system, according to Anthony. MACRA achieves this through two key pathways: merit-based incentive payment systems and APMs.
“There is an ‘overriding principle of minimizing the reporting burden.’”
Merit-based incentive payment systems
As Anthony explained, MIPS has three main goals: to provide better care, utilize smarter spending and achieve better health outcomes. Incentives will help accomplish these benchmarks, such as value-based payment, reformed care delivery and information sharing across multiple settings through strategies like care coordinating.
To be sure, CMS recognizes that there is no one-size-fits-all solution, and that’s why the organization offers multiple pathways with varying levels of risk and reward for providers to achieve the goal of tying more payments to value. However, Anthony noted that there is one overarching principle that just about every medical facility can relate to.
There is an “overriding principle of minimizing the reporting burden,” Anthony said at the summit.
He explained that he often hears physicians complain that they report the exact same data to several different places. The CMS hopes to target this pain point so that participation in and of itself does not become a burden and the healthcare industry can reach those main payment reform goals.
How does the CMS plan to mitigate reporting barriers? The MIPS combine several systems, including the physician quality reporting program, value-based payment modifier, and the medical electronic health record incentive program. This streamlined method means physicians don’t have to enter data into multiple platforms.
Alternative Payment Models
APMs, such as patient-centered medical homes, accountable care organizations and bundled payment models, are another path for physician compensation. As an incentive to adopt this method, the CMS offers physicians a 5 percent lump sum bonus on top of the rewards reaped from MIPS adjustments.
Making connectivity a priority
This payment shift requires states to think about steps they must take to drive the adoption of these new models. For example, what services do states require? What capabilities do they need? Answering these questions will help the regions facilitate proper data management.
Standardized, structured and actionable data that reflects shared expectations from all stakeholders is key to interoperability. Overall, this can paint a more accurate picture of the individual and patient population, and thus fuel better health outcomes.
Subscribe to View the HD Video Presentation | Health Care Payment Reform: New Policies Framing the Opportunities for HIT
• Rob Anthony, Acting Group Director of the Quality Measurement, Value-Based Incentives Group, CMS
• Kelly Cronin, Health Reform Coordinator, ONC/HHS
To learn more about opportunities to participate at the 2017 State HIT Connect Summit, please email Victoria Smith, Communications Director, Healthcare IT Connect email@example.com