The era of value-based healthcare is (almost) here.
The Centers for Medicare and Medicaid Services (CMS) recently proposed a new program that would further shift the nation’s healthcare system away from the fee-for-service payment model, and more towards value-based care. The proposed Quality Payment Program (QPP) is part of the agency’s implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the bipartisan “doc fix” and children’s healthcare extension that became law in 2015.
QPP would create a “unified framework” for transitioning the national insurance program for seniors towards outcomes-based payments, according to CMS. The proposed payment program will include two payment pathways: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). These would replace “a patchwork of programs, including the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.”
Under the proposal, a provider’s MIPS score initially will be comprised of four parts: cost (10 percent), quality (50 percent), clinical practice improvement activities (15 percent) and advancing care information (25 percent). The MIPS score will then be used to determine if a provider is reimbursed more than, less than or at the standard Medicare rate. In addition, certain providers will be eligible for an exemption from the MIPS system by participating in APMs—specialty incentive payment models proposed under QPP.
The public comment period for QPP ended June 27, 2016.
Of course, performance-based reimbursement is not an entirely new concept in healthcare. Today, most groups’ reimbursement is based on its Clinical Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey score. Conducted annually, this survey attempts to measure patient satisfaction based on a variety of healthcare experiences, such as communication with medical providers or pain management after a procedure is complete.
As a result, successful practices are taking their own snapshots of patient satisfaction and other operational and clinical factors. Proactively measuring ongoing performance allows physician leaders to make the necessary adjustments before reimbursements are affected and a group’s bottom line suffers—an activity that inevitably will become more important in the coming era of value-based care.
Conduct internal surveys Sensing a growing need for more accurate and efficient practice information regarding patient satisfaction, valuable tools like Survey Vitals help physician groups better assess their performance. Conducting internal surveys independent of those required by the federal government provides practices with the opportunity to better understand the intricacies of the satisfaction metric.
For example, the CG-CAHPS survey delivers information based on the last three to six months; as a result, practices may not know about an internal issue or weakness until it has been happening for 180 days. Tools like Survey Vitals have 24-hour turnaround times, providing real-time data to practices at an affordable cost. In addition, these tools can be catered to specific medical specialties, offering relevant feedback that providers can immediately act upon to reduce errors and operational inefficiencies while improving patient satisfaction.
Generate actionable reports In an era of increased pressure to lower costs and expand productivity, physician groups that show a proactive interest in adding value to the organization are especially attractive to hospitals and health systems.
While CG-CAHPS and Hospital Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) surveys may provide skewed, old or irrelevant information, physician groups can use specially designed electronic surveys to generate actionable reports that detail strengths and weaknesses. And presenting these reports to hospital leaders and tracking progress over time shows initiative in an increasingly competitive healthcare landscape.
Leverage data Equipped with detailed patient satisfaction data, physician leaders must use this information to move their practices in the right direction. Identifying areas for improvement and appropriately addressing deficiencies to increase satisfaction survey scores is the critical final step in improving patient outcomes and overall satisfaction. As survey scores continue to further affect reimbursement, groups must leverage their data to make better-informed decisions regarding clinical care, operational efficiencies and practice performance.
According to CMS, hospitals could stand to lose or gain 2 percent of reimbursement dollars by 2017, depending on their H-CAHPS scores. For a typical hospital, that could put as much as $850,000 at risk annually. There is an upside. Under proposed changes, a hospital with $120 million in annual revenues could also receive as much as $5.4 million in additional incentive payments, according to a report by Press Ganey.
In healthcare, measuring performance is no longer optional. It is vital for success in today’s competitive market. As a result, patient satisfaction surveys provide physician leaders with a real-time snapshot of a practice’s performance, allowing the necessary adjustments to be made to ensure optimized cash flow.