Value-based care has been a bit of a slow burn in healthcare, but its moment has arrived. Medical practice leaders can now respond to cuts in Medicare reimbursement with a strategic approach to value-based incentives – one that's dedicated to bettering patient outcomes.
But executing this strategy is no easy feat. To successfully navigate Medicare physician reimbursement cuts and the transition to performance-based contracts, you'll need a strong understanding of value-based care models and how to build a great team, as well as smart tactical choices, like setting up a point-of-care lab in your medical office.
Value-based care & alternative payment models: What's changed?
Since 2015, the Centers for Medicare & Medicaid Services (CMS) has been on a mission to leave behind fee-for-service payments and move toward reimbursement models that reward sustainability, quality outcomes and lower costs. The agency has achieved this by merging the Value-Based Payment Modifier, the Physician Quality Reporting System and the Electronic Health Record Incentive into the Merit-based Incentive Payment System (MIPS) under the Quality Payment Program.1,2
As a result of the 2021 Final Rule, the program has seen a few recent updates:3
- Changes to quality and cost performance category weights
- Minimum threshold and payment adjustments
- Adjustments to the Quality Performance Category Postponement of the MIPS Value Pathway (MVP)
- Introduction of a new Alternative Payment Model (APM) Performance Pathway
CMS has now opened applications for the second cohort of the Primary Care First (PCF) value-based payment model, with the intent to further reduce Medicare costs while increasing quality of care.4
Best practices for taking advantage of value-based care
These recent changes mean that individual practices need to take a careful look at their businesses, reporting and patient outcomes in order to navigate the shift in primary care reimbursements. As CMS continues to make changes, physicians will need to invest in best practices to support success in an outcomes-based environment that takes full advantage of MIPS and MACRA incentives. Here are some suggestions offered by the American Academy of Family Physicians (AAFP).5
1. Get to know your patients' data
If you're working with population-based payment models, careful use of patient attribution (a method of identifying the patient-provider healthcare relationship) will be critical.6 A 2018 study of five commonly used patient attribution methods found that reliable patient attribution was fundamental to the accurate evaluation of healthcare processes, efficiencies and outcomes.7 To support attribution efforts, practices will need to fully report on quality measures to meet the higher performance threshold of 60 MIPS points and avoid penalties.3
The takeaway here is that practices like yours can benefit from developing processes and investing in data collection that enables full reporting on quality measures (if this is not already in place). Pay close attention to quality measures in the following categories:
- Activities and habits that contribute to positive health outcomes (e.g. discharge support, clinician engagement and use of technology)
- Measures of care effectiveness (e.g. emergency room visits and readmission rates)
- Patient satisfaction
Additionally, your physicians need timely access to patient data, so make sure your electronic health record (EHR) system and practice management software are up to the task.
2. Build a great team
Success in prioritizing positive outcomes for your patients will rely heavily on your team. You will need a team that's dedicated to identifying your high-risk patients, engaging in proactive care and then moving on to monitor the patients' progress within your quality metrics.
You might already have an amazing team on board and will be able to move forward with simple training and strategic conversations. It's also possible, though, that you will need to think about bringing on new personnel. To self-evaluate, consider whether you currently have coverage for the following functions:
- Updating missing metrics
- Reviewing patient experience surveys and relaying feedback to physicians and staff
- Making sure quality metric data is properly assigned
- Communicating with patients who need to come in to meet specific quality metrics
- Ordering protocol-based studies and labs needed to meet outcome metrics
Make sure you're supporting your existing team to do their best work. According to a Deloitte survey, physicians acknowledge the value of clinical protocols and want involvement in their development. In fact, three out of five physicians report that the positives of having protocols outweigh any negatives. Additionally, physicians with access to clinical protocols tend to have more positive views toward value-based payment models as well as efforts to measure performance, cut costs and reduce clinical variations.8
3. Prioritize pre-visit planning
Consider implementing pre-visit checklists that anticipate both a patient's medical needs and the specific quality measures to focus on during the visit. This list is an opportunity to standardize tasks such as ordering labs based on a patient's medications and making any test results available for review during the appointment. Pre-visit planning is an especially important tactic for patients with complex care needs who may require screening for risks such as falls, depression or tasks related to medication management. Keep in mind that this is also a tremendous opportunity to plan for how a patient will experience their visit.
4. Set up a POC lab in your medical office
As you're exploring ways to improve the patient experience, consider your approach to lab testing and opportunities for expanding point-of-care (POC) laboratory testing.8 Making the shift from CLIA-waived to moderately complex testing at your practice can support outcomes and improvements in efficiency, all while enhancing the patient experience. By performing labs in-practice, you can offer your patients much greater convenience and shorter wait times for results. Results that are processed more quickly support operational efficiency and pave a shorter path to patient compliance, new revenue and improved outcomes.
Conducting POC laboratory testing requires technology including reader technology, rapid tests and molecular technology. It may also require specific personnel like lab directors, supervisors and medical technologists.
Moving forward into value-based care success
Overall, value-based care is a moving target, requiring practice managers to pay close attention to the outcomes of individual programs. However, understanding the trend and being strategic about putting certain best practices in place will help you to succeed in a landscape of value-based care and outcome improvement initiatives.
For more information on POC laboratory testing, request to speak with a sales representative. Armed with LabTec, they can help you best assess opportunities for bringing lab testing in-house.
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