PERC - Introduction

Thursday, April 11, 2013 02:00 PM

Practice Evolution Reality Check (PERC): How CMS can help you track, assess, and adapt your practice to the impending state and federal shifts in public and commercial payer reimbursement policies and the related incentives and disincentives that will directly influence your practice patterns and business decisions.

The Patient Protection and Affordable Care Act (HR 3590), signed into law (P.L. 111-148) on March 23, 2010, as amended by its companion law, the Health Care and Education Reconciliation Act (H.R 4872) and signed into law March 30, 2010 (P.L. 111-152) codifies and accelerates the mega trend shifts to value-based purchasing and outcome-based reimbursement by Medicare and thus other payers, creates a complex set of public and private mechanisms to extend coverage to the uninsured, puts commercial plans under unprecedented federal oversight, and creates a federal-reserve-like authority to set national health care policies that will be felt from the exam rooms to the operating rooms and all settings in-between.

Anticipating, then translating the consequences of these massive shifts in federal and state health care law and their related regulatory implementations into practical, exam room level consequences can’t be divined in a single reading. Ongoing diligence and connecting with colleagues and support systems like CMS will be vital, because unlike prior medical experience with shifts in federal or state policy, these changes are well underway. Significant elements of this complex set of federal laws are already in effect, and most of the remaining pieces will be in full force by 2015.

Some policies will start locally as pilots and then metastasize across regions and state lines because Congress intentionally transferred to the executive branch the authority to expand whatever they determine works without further political intervention. That section of the law reads, in part: “The secretary of health and human services (HHS) is empowered to expand successful pilot programs without the need for additional legislation.”

Colorado is already piloting several innovations in care coordination and cost-curve bending. A large pool of physician and health care policy experts, well advanced in their knowledge and experience, are engaged in CMS’ PERC efforts to connect their peers to each other and provide ongoing guidance and insight.

This Practice Evolution Reality Check, or PERC, scans the macro-factors drawn from the federal law that will alter every clinical and financial aspect of medical practice and assess its probable influence in most practice settings. It presents a consensus view of state experts on where Colorado and federal health care delivery systems are likely headed and provides you with regularly updated access to the information, resources and help that are needed to successfully evolve your practice. PERC will offer the current thinking and advice from some of Colorado’s top health care analysts and professionals.

Your county medical society and Colorado Medical Society are working closely together in a common effort to connect you with the expertise and insights that will help you adjust your practice during these volatile but inevitable changes. This requires some tradeoffs in time and effort by you and your staff to get up to speed, but it will be time well spent.

Given the complexity and uncertainties of this “mediquake” and the sheer volume of technical information associated with it, we suggest you:

• Read the scan and identify what is most relevant to you and to your practice.
• Choose a practice evolution project that fits best with your current situation and start there; move at your own pace; use the resources that are embedded and linked to the PERC.
• Map out a plan or steps to take that have you and your practice prepared by the effective date or deadline, if applicable.
• Ask for help from your panel of PERC experts, your local peers in your County Medical Society, and CMS. We can keep you connected and informed.