collaboration between providers and payers. Payers are eager to get their hands on clinical data, and some payers are actually starting to mandate that physicians or groups submit clinical data along with claims data just to get reimbursed under feefor-service. Other payers are taking a slightly more passive route, saying, “We’ll give you a bonus payment if you submit some clinical data.” Right now, some payers are so anxious to get the data that they are sending patient assessment forms via fax, or they are asking you to log in and submit data via a portal or other means. That creates a vast amount of additional administrative work.
MR. FLOTT: Over the last five years, mergers
and acquisitions between health systems have become huge. The investments required to implement population health systems and other transformations is really expensive. It’s one thing to come together and put on a new name. Integration is a lot harder to do. It’s difficult for both organizations and physicians. I’ve got to keep one foot on the dock. I’ve got to keep an eye on the fee-for-service activity that allows us to conduct our mission. But I also have to stretch the leg over on the other side of the boat and find ways to innovate and find things to change.
What are some of the challenges that value-based reimbursement faces in becoming adapted? DR. KLEEBERG: Value-based care and value-based
payment, in the long run, are going to support the reason we went to medical school: to keep our patients healthy and happy. Under fee-for-service, especially when you’re working in a large integrated delivery system, your pressure is to move people through rapidly, and that takes a lot of the pleasure out of care. With value-based care, we will all have skin in the game, so I think the oversight will be easier. There is no intrinsic challenge in value-based care itself. The challenge is in the rules, the regulations, and all the steps you need to follow to demonstrate that what you’re doing is value-based. In the grand scheme, value-based care is going to work extremely well. It’s just going to be a painful transition process. MR. MELLOH: My impression is that the adoption
of value-based reimbursement is less difficult for primary care physicians than for a lot of specialists, whose practice has been oriented toward much more high-end fee-for-service work. I don’t mean to sound cynical about it, but they may be less inclined to gravitate toward a model in which they’re looking at the overall health of the patient as the outcome. MS. SIMM: We need more patient input. That
might mean a paper survey, right there in the office, to collect meaningful data up front. If I’m having my hip replaced, I may not expect to run any 5Ks or do any couch-to-5Ks. My sole hope may be to walk down the aisle, and if you do that for me, I will think you succeeded. We should have those conversations about shared outcomes up front, and then measure against that.
What challenges do fraud and abuse regulations based on the fee-for-service model and now switching to this value-based model present? MR. D’EMANUELE: Evolving reimbursement rules
present incentives for all the different providers to work together more carefully, to coordinate care, and to do things more efficiently. The problem is that the fraud and abuse rules are the same rules we’ve had for 25–30 years. Say I’m a post-acute care provider, and I want to give data to physicians about referral patients, or I want to give them access to an application or give them a license to an application that I bought so we can coordinate care better and prevent patients from being readmitted to the hospital. Is that data of value to a referral source—do I have to worry about paying a kickback to physicians? Is that license that I’ve given them to a paid application a problem under the kickback statutes? It isn’t always, but the fact that we have to ask those questions is emblematic of the problem. My approach is always that if we can justify and document that we’re doing this to take care of patients and to get to the right results in terms of reducing readmission or any other metric, then we should feel confident in proceeding. MR. MELLOH: Those barriers are much less significant
and prevalent in an integrated health system model where you have employed physicians. One of the implications of moving toward a value-based reimbursement model could be further consolidation of the industry so as to facilitate greater integration and sharing of data within a system.
A big part of success in value-based care is ensuring that patients actually participate in their own care. —David Melloh, JD
What are the most common misperceptions about value-based reimbursement? MR. D’EMANUELE: Reporting is difficult under the
new MIPS. From what I can tell, there are some 200 choices you can make. You have to report six or nine quality measures in order of magnitude, and you get to pick them from a wide array of quality measures. You have to pick some that are outcome oriented, and there are categories that limit your choices, but there are choices. It was meant to give flexibility to physicians so that they could make choices that are meaningful to their practice and, hopefully, are measures that they can do well on. And that’s just Medicare. Other commercial payers might ask for different things.
MS. LAVALLEY: When you hear “value-based
reimbursement,” you think that just the payment is changing, but there are two sides to the coin. First, how do you achieve better patient outcomes, higher quality, and lower cost? Second, how is the payer going to reimburse you, what are the actual mechanisms of payment types, and when are they going to come in? Do you get a payment and then have to pay something back at a later date? Sometimes we don’t talk enough about both sides. MR. FLOTT: I think the perception of value-based health care is in the eyes of the beholder. Many physicians, admittedly, may not understand what’s happening. I also think patients need to
Mayo Medical Laboratories MARCH 2017 MINNESOTA HEALTH CARE NEWS
Published on Mar 8, 2017
Published on Mar 8, 2017
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