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HIMSS 2016, Part 2

By: | Tags: , , , , , , , , | Comments: 0 | March 10th, 2016

As we noted in our last blog “every year the best and the brightest in health information technology industry via the Healthcare Information and Management Systems Society’s (HIMSS) annual meeting meet for a week. This year it was in Las Vegas, Nevada. I will admit, I missed it; and maybe I should have gone to this one. I have received 100s of industry emails. Something certainly happened; so I will take two more blogs, this and the next, and move on to other things.

There has been major talk about Medicare moving further away from fee-for-service to a value based reimbursement (VBR) . The drive is to increase the VBR payments from 30% to 50% by 2018 and total quality based payments from 85% to 90%. What does this really mean and how does that play in to technology, EHR an even Meaningful Use?

VBR is a care-management strategy that pays doctors for pursuing high quality while simultaneously reducing costs. VBR can be used along with pay for performance (P4P), bundled payments, capitation, and shared savings through accountable care organizations (ACOs). I have to acknowledge those are all terms and strategies that I think are very positive and where we need to go in healthcare.

The move to a more managed care drive has been slow, starting in the 80s, picking up steam in the 90s. I believe we are past the inflection point, and in to the vertical growth. It’s happening along the same time EHR and patient portals are growing dramatically, and therefore changes the tools available to the industry and to care givers.

Many doctors, however, remain doubtful, even skeptical of the purported advantages of VPR for patients and for their practices. For example, a study last year reported that 60% of practices weren’t willing to join ACOs.

Let’s be clear. VBR is obviously positive for insurers (including Medicare) in that it can lower costs; but does it bring benefits to the patients and the provider.

At HIMSS last Wednesday, officials from the Centers for Medicare and Medicaid Services (CMS) said “physicians should expect meaningful use of electronic health records to still be required under coming changes to how CMS pays them under MACRA” .

MACRA is the law that fixed the Medicare Sustainable Growth (SGR) we have talked about before, but also permanently put on track the change in VBR modeling. CMS said “Our intent is to have a single, unified program,” while at the same time offering flexibility and avoiding a one-size-fits-all approach. “We know physician practices are very different from one another.”

Though the plan is still under development, the new rule will reimburse physicians based on four factors; grading them with a composite performance score factoring in their quality measures (30 percent), resource use (30 percent), clinical practice improvement activities (15 percent) and meaningful use (25 percent).

VBP incentive payments are set to begin Jan. 1, 2019. As separate payment adjustments under the Physician Quality Reporting System, Value-Based Payment Modifier and the meaningful use program will sunset Dec. 31, 2018, according to CMS.

Meaningful use (MU-2 today) will still be a core component of the US government’s new VBP programs guaranteed in to the next decade, and irrespective of who is the US President. More on that last subject in a future blog.

–  Noel J. Guillama, President

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

http://www.aafp.org/practice-management/payment/medicare-payment/faq.html

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