Reimbursement News

4 HIMSS16 Revenue Cycle Management, Value-Based Care Focuses

The future of revenue cycle management is about the evolving role of the consumer.

By Jacqueline DiChiara

- The topics of revenue cycle management innovation and value-based care will be of key importance at HIMSS16, one of the largest healthcare information technology (IT) conferences of the year, held next month in Las Vegas.

HIMSS16 revenue cycle management claims management

Promoting financial transparency, ensuring timely and accurate claims management, and improving patient satisfaction levels with the billing experience are all expected to be top priorities for speakers and attendees.

The new future of revenue cycle management is perhaps about the evolving role of the healthcare consumer – one who is a consumer, patient, and payer.

A successful revenue cycle is patient-centric, said Stuart Hanson, Chair and Senior Vice President of the HIMSS Revenue Cycle Improvement Task Force.

"Providers and plans have recognized the need to collaborate to provide a more consumer-friendly revenue cycle experience,” he stated.

"It is important to bring parties together to discuss how financial transactions can become more transparent," asserted Mike Olson, Senior Vice President of Healthcare Solutions at Fifth Third Bank.

This way, “everyone understands what their financial responsibilities are – from the patient all the way to the payer and provider.”

Here are 4 top revenue cycle management terms expected to generate a great deal of discussion as the healthcare industry congregates shortly in Las Vegas. Selected highlights of revenue cycle-based speakers, talks, and keynotes are included.

The future of value-based care

Sylvia M. Burwell, Secretary of the Department of Health and Human Services (HHS) will deliver one of HIMSS16's keynote addresses.

Nearly one year ago, Burwell announced HHS’s goal to tie 30 percent of fee-for-service Medicare payments to value-based payment models.

Burwell's future objective, which builds off of the basics of the Affordable Care Act (ACA), is to tie 85 percent of traditional Medicare payments to quality by 2016 and 90 percent by 2018.

“We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement,” Burwell said.

“Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in our common interest to build a health care system that delivers better care, spends health care dollars more wisely and results in healthier people."

Healthcare providers operating under the value-based reimbursement model are reportedly seeing many benefits compared to the fee-for-service system.

There was an 18 percent dip in costs among over 1 million members treated by providers under a value-based reimbursement model, according to research from Humana.

“The positive impact of the value-based model in Medicare Advantage also reflects Humana’s support of the goal of the Department of Health and Human Services of tying 50 percent of traditional, or fee-for-service, Medicare payments to quality or value by 2018,” Humana stated within a press release.

“The provider community’s embrace of the value-based reimbursement model and continued dedication to patient care, combined with the population health capabilities from health plans, is proving to produce better outcomes for patients, physicians, health plans and society as a whole,” said Roy A. Beveridge, MD, Humana’s Chief Medical Officer.

“As a physician who has practiced for more than 20 years, the value-based model supports the holistic approach to care that is necessary for effective population health management.” 

Accountable care organizations

Burwell’s aforementioned announcement also described an action plan of sorts regarding the relatively new accountable care organization (ACO). Key objectives include the reduction of unnecessary spending, stronger outcomes, and greater levels of coordinated care.

“The setting of target dates for the transition from pay-for-volume to pay-for-value means that provider organizations must ramp up their own preparations for adopting an approach that emphasizes population health management. But the infrastructure to do that is largely nonexistent in most current ACOs,” says David Wennberg, MD, MPH, CEO of the Northern New England Accountable Care Collaborative (NNEACC).

Successful healthcare providers must grow accustomed to delivering high quality care within tight budgetary restrictions.

Value-based incentives are a top focus to help get the ACO ball rolling and promote low cost, high-quality care, states a report from the Health Technology Transformation.

“Whether an ACO is hospital-led or physician-led, it needs deep pockets to build the necessary infrastructure and hire sufficient care managers,” said the report.

Pay-for-performance incentives are positively impacting physician behavior, according to a recent JAMA Pediatrics study.

“ACOs are responsible for healthcare costs and quality across a defined population. To succeed, the ACO must improve value by reducing costs while either maintaining or improving the quality and outcomes of care,” stated researchers.

Looking back (and ahead) at ICD-10 implementation

Revenue cycle management is a big post-ICD-10 implementation focus.

Ninety-nine percent of healthcare organizations said they were well prepared for ICD-10 implementation switchover on October 1, 2015, confirmed recent data from Porter Research and Navicure.

Reflection upon the first 180 days of ICD-10 implementation will nonetheless likely be a third hot topic at HIMSS16. Claims denial rated and pended claims rates related to revenue neutrality will be discussed.

Bonnie Sunday, MD, for instance, will be speaking on March 1 at a State of the Union presentation entitled, “ICD-10: The First 180 Days – HIMSS ICD-10 Task Force Perspective.”

In another chat on March 2, “ICD-10: Celebrating Success? A Conversation with HIMSS ICD-10 Task Force,” ICD-10 Task Force members will discuss ICD-10’s struggles and opportunities.

MACRA’s greater influence

How is the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 affecting the healthcare industry? This will be one of many discussions unfolding at HIMSS16.

MACRA’s influence on Meaningful Use changes was a concern for providers as last year came to a close.

The Centers for Medicare & Medicaid Services (CMS) released a quality measurement draft plan under MACRA last December.

MACRA fee adjustments tied to a $200 billion Medicare reform package were expected to financially hurt physicians and healthcare providers.

MACRA is a key discussion point within one March 2 HIMSS16 session featuring speaker Robert Jarin, JD, BA.

The shift to value-based medicine, alternative payment models (APMs), and the Merit-Based Incentive Payment System (MIPS) will be one of many key discussion points. Rulemaking for both APMs and MIPS begins this year with implementation kicking off in 2019.

In light of such developments, CMS recently posted a Measure Development Plan for APMs and MIPs to help alleviate physician burden.

CMS said goals to tie 30 percent of Medicare payments to value via alternative payment models by the end of this year, and half by the end of 2018, are indeed “measurable.”

“The passage of the Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015 (MACRA) supports the ongoing transformation of healthcare delivery by furthering the development of new Medicare payment and delivery models for physicians and other clinicians,” CMS stated.

“CMS is committed to reducing provider burden through the use of measures aligned across federal and private-payer quality reporting programs. We stress harmonization of data elements and specifications among measure developers, whose cooperation and sharing are essential to creating aligned measures.”