What is the New Future of Value-Based Payment Programs?
By - Medicare’s value-based payment programs provide physicians with purposeful information that can be intelligently acted upon to resultantly strengthen care quality. As the shift from physician reimbursement moves from the realm of volume to one of value, there is now a greater recent focus among healthcare providers and professionals on providing high quality of care for patients.
Two parts of the value-based payment program provide physicians and medical groups with greater access to comparative performance information about Medicare beneficiaries. The first is Quality and Resource Use Reports (QRURs), providing various value-based quality and cost measures to enhance coordination among physicians. The second is the value-based payment modifier which gauges care quality in relation to cost.
Because of these programs, progress across the healthcare industry is changing the status quo payment landscape to an individualistic-centered system. Value-based payment programs that enable healthcare providers to keep costs low and quality high fortify common standard adaptation across the board and promote cleaner communication lines with the promotion of coordinated care.
CMS makes value-based waves
There is a lot of moving and shaking in the healthcare industry around value-based payment efforts lately. According to the Affordable Care Act (ACA), The Centers for Medicare and Medicaid Services (CMS) will begin applying a value-based payment program under the physician fee schedule within the year, to be executed in regard to budget neutrality. As per the ACA, CMS allows both physicians and medical practice groups to garner more information about their resource use and cost algorithms related to care quality.
The push for payment that rewards value is very much alive and well. This month, CMS announced the promotion of a value-based care delivery model which ties payment increases or decreases to quality performance among home health agencies. According to this week’s announcement from CMS, Medicare will transition into a bundled payment model for hip and knee replacements. As the most common inpatient surgery for Medicare beneficiaries, in 2013, 400,000 inpatient primary procedures cost $7 billion – for hospitalization alone.
Sylvia M. Burwell, Secretary of the Department of Health and Human Services (HHS), recently proposed fixed Medicare payments for the complete cost of hip and knee replacements among 75 metropolitan regions. Hip and knee replacement will therefore be treated as a singular service from the day the surgery is performed to 90 days later. Such a proposal aligns with CMS’s goals to push hospitals and healthcare providers to value-based payment where payment is connected.
The proposal enforces a value-based purchasing model on all Medicare-certified home health agencies as part of a template-based pilot program. Key objectives include recovering overpayments and enforcing a 1.72 percentage point cut within the next 2 years to the standardized episode payment rate.
Is interoperability the new future of a value-based healthcare system?
According to CMS, such initiatives promote enhanced success. CMS states that "effective adoption and use of health information exchange and health IT tools will be essential as these settings seek to improve quality and lower costs through initiatives such as value-based purchasing."
“An interoperable health IT ecosystem should support critical public health functions, such as real-time case reporting, disease surveillance and disaster response, as well as data aggregation for research and value-based payment that rewards higher quality care, rather than a higher quantity of care,” states the Office of the National Coordinator for Health IT’s interoperability roadmap. “As HHS continues to test and advance new models of care that reward providers for outcomes, it will help to create an environment where interoperability makes business sense.”
