As you are probably well aware, medical reimbursement for physician practices is transitioning from a quantity to a value measurement. Under this value-based compensation (VBC) model, physicians will soon be rewarded for providing higher quality care and penalized if they fail to meet established benchmarks. This is already the case for hospital reimbursements under Medicare and Medicaid, and commercial payers are following suit.
According to the Centers for Medicare and Medicaid Services (CMS), “In calendar year 2017, Medicare will apply the Value-Based Payment Modifier … to physician payments under the Medicare Fee Schedule for physicians in groups with two or more eligible professionals and physician solo practitioners.” While 2017 may seem like a long time away, 2015 is the actual performance lookback period for VBC.
The ultimate goal of VBC is to improve patient outcomes and the patient experience while reducing costs for care. And there is a good reason why: Under the current fee-for-service system, there has been an increase in both the number of patients seen per physician, as well as an overall increase in the amount of medical services provided. This can create a number of issues, including the following:
- Physicians spend less time with patients.
- Practices are forced to stretch their administrative and staffing resources.
- The potential for medical and administrative errors can increase.
- Coordination of care and management of patient conditions outside of face-to-face can be challenging.
Recognizing that this shift in reimbursement will pose even more challenges for the already overwhelmed physician, CAP recently published The Physician’s Action Guide to Value-Based Compensation, available for free to CAP members. This 24-page guide provides a thorough overview of value-based compensation and offers recommendations on developing a plan to help ensure you are compensated fairly for the care you and your staff provide.
In addition, in early 2016, CAP will be offering members access to a superior patient experience survey tool, as the patient experience is one of the key areas payers will measure when evaluating overall outcomes. We are currently piloting the program with a limited number of members to ensure we have a solid tool to offer when we roll out the program to our entire membership next year.
CAP is excited about its new VBC initiatives. If you would like to receive a free print or digital version of The Physician’s Action Guide to Value-Based Compensation, call CAP Membership Services at 800-610-6642 or ms@CAPphysicians.com