Private insurers and the government are increasingly pushing for value-based reimbursement (VBR) of providers, leading to a shift from the traditional physician compensation model toward a new focus on quality outcomes. With VBR becoming less a matter of “if” and more of “when,” savvy physician practices are beginning to familiarize themselves with how it works so they can make the transition more smoothly when the time comes.
The Patient Protection and Affordable Care Act (PPACA) offers a number of options for providing care and paying providers, including the formation of accountable care organizations (ACOs). The CMS will reward ACOs that reduce costs while meeting performance standards on quality of care.
Provider participation in ACOs is purely voluntary but, even if you’re not planning to join one, you’re likely to find yourself operating in a new compensation environment in the near future. It’s likely that compensation will reflect quality instead of volume, taking into account physician performance metrics such as efficiency, coordinated care and patient satisfaction.
Indeed, by 2015, the health care act requires the CMS to begin applying a “value-based payment modifier” under the physician fee schedule. Although the modifier will initially apply only to practices with 100 or more eligible professionals (including nurses, physician assistants and other nonphysician staff), it’s scheduled to apply to all physicians and groups by Jan. 1, 2017.
POTENTIAL VBR COMPENSATION MODELS
Since the passage of the health care act, several models of value-based reimbursement have emerged, including:
Pay-for-performance. Under this hybrid model, physicians are paid a negotiated payment for each service, with additional incentives based on costs, quality and patient experience.
LBMC has a long history of providing quality services to many healthcare organizations across Tennessee and the U.S. We have approximately 400 professionals across three offices: Nashville, Knoxville and Chattanooga.
Specific to the healthcare industry, our accomplishments include successfully leading various industry engagements including:
- Performing financial and compliance attest engagements
- Performing reimbursement and cost report preparation engagements
- Preparing federal and state income tax returns
- Due diligence in connection with potential transactions
- Advising clients on opportunities to expand services and ensure growth
- Providing assistance in developing strategy and strategic plans
- Ensuring compliance with state and federal laws and regulations
- Preparing for and safeguarding clients from HIPAA and RAC implications
- Providing assistance with strategic community health needs assessments and Schedule H of IRS Form 990