PERC - Reimbursement Changes

Thursday, April 11, 2013 02:25 PM

The impending shift from fee-for-service to outcomes-based reimbursement

Three specially-created federal sub-agencies will coordinate and direct Medicare and Medicaid payment policies, all with the global intention of reducing unwarranted variation in care, improving outcomes and (by definition) the value of services delivered. Commercial health plans are expected to follow right behind these changes by public payers. Fee-for-service reimbursement will be replaced over time with reforms such as value-based payment modifiers and bundled or global payment systems that are based on outcomes, not volume. The Independent Payment Advisory Board (IPAB) will devise changes to the Medicare payment system, Patient Centered Outcome Research Institute (PCORI) will focus on comparative effectiveness research, and the Center for Medicare and Medicaid Innovation will test new payment methods and health care delivery systems that reduce cost and improve the quality of care. Each of these federal sub-agencies has been endowed with unique and unprecedented authority to pursue and adopt policies as their own research results surface.

Efforts to enhance transparency of data and publically report individual and group performance will increase with the rollout of the Physician Compare site. The first phase of this site launched Dec. 30, 2010. (More information is available here). More locally, Colorado’s own Center for Improving Value in Health Care (CIVHC) is not waiting for federal action. CIVHC has already begun to transparently design and drive private sector payment reform in the state. CIVHC was supported by CMS as a preemptive move to bring payment reform out into the open so all stakeholders–providers, payers, business, and patients–could participate from the ground floor up.

Understanding and preparing for new systems of reimbursement is critical to any physician’s practice.