Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Value-Based Incentives Top Practice in Reimbursement Model

By Sara Heath

- Value-based incentives may be gaining momentum as integral parts of physician reimbursement models. A recent survey by Sullivan, Cotter, and Associates confirms that using quality-based incentives and quality metrics are becoming more prevalent methods of physician compensation.

The Physician Compensation and Productivity Survey, which surveyed nearly 115,000 physicians from approximately 560 organizations, concludes that value-based incentives are among the top practices for physician compensation. Of the surveyed organizations, 45 percent use quality metrics in physician reimbursement models, which is 13 percent more than two years prior.

The survey also collected data regarding how much physician compensation is derived from quality incentives. On average, physicians received $18,500 from quality incentives, or about 6 percent of physicians’ total cash compensation.

SullivanCotter officials say that this is a natural progression as organizations, such as the Department of Health and Human Services (HHS), continue to emphasize the importance of value-based incentives. According to Kim Mobley, Managing Principal at SullivanCotter, as the emphasis on value-based incentives increases, pay-for-performance compensation increases as well.

value-based incentives are increasingly becoming a part of physician reimbursement

This information is notable considering the push to value-based care from federal healthcare agencies. As reported earlier this year by RevCycleIntelligence.com, the HHS announced its timeline of converting 30 percent of Medicare payments to value-based payments by 2016. HHS plans to do this by transitioning fee-for-service payments to alternative methods such as bundled payments and accountable care organizations (ACOs).

In order for healthcare facilities to transition to value-based incentives, experts say it is critical payers adopt value-based payment models. By linking a physician’s pay to the quality of care he or she provides, it is expected that the quality of care and care coordination increases.

“Non-productivity incentives play a key role in the current compensation arena and will continue to gain importance in future years,” said Justin Chamblee, Senior Manager at the Coker Group, in a in an article. “But you cannot incentivize physicians based on outcomes, when all your reimbursement is on fee for service.”

These payment models may also make financial sense, as reported by RevCycleIntelligence.com. Increasing the quality of care, especially at the primary care level, may result in healthier patients who may not need to seek higher-cost care further down the road. For example, the Blue Cross Blue Shield Association reported saving $500 million in 2012 due to the implementation of value-based payment models. Savings were found in reduced emergency room visits, hospital admissions, and cost of care for diabetic patients.

As the shift from fee-for-service to value-based payment models continues, federal agencies like HHS remain certain that fee-for-performance models will increase care quality across the healthcare spectrum, streamlining care delivery and decreasing healthcare spending.

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