Since Secretary of Health and Human Services (HHS) Sylvia M. Burwell’s announcement in early 2015, we can now definitely say that health care payment is shifting towards value-based payment. Though we have seen some change over the years among commercial payers, HHS’ historic announcement has set clear, explicit goals to tie payment to value in a measurable way:
- 30 percent of Medicare payments will be through alternative payment models (e.g., ACO and PCMH) by 2016 and 50 percent by 2018.
- HHS will tie almost all payments to quality: 85 percent by the end of 2016 and 90 percent by 2018.
To keep current with the changes, California family physicians in this new health care environment must understand value-based payment models. In the words of Secretary Burwell, it is time to make some real “progress towards achieving better care, smarter spending, and healthier people.”
Medicare Access and CHIP Reauthorization Act of 2015
On April 14, President Obama signed the Medicare and CHIP Reauthorization Act (MACRA), which finally repealed the flawed Sustainable Growth Rate formula. MACRA accelerates our movement towards value-based payment. While the fee-for-service payment model will remain the base methodology for Medicare, starting in 2019 CMS will adjust the payment of providers who participate in the Merit-Based Incentive Payment System or Alternate Payment Models. On April 27, 2016, CMS issued a proposed rule to implement key parts of the MACRA law. CAFP urges California family physicians to prepare for the implementation of this law and we will help you along the way. In coming months, we will make tools and resources available that guide you through changes your practice can make to prepare for value-based payment and MACRA. The first step is to understand how the law and regulations will affect you.
For more information, check out CAFP’s MACRA webpage.
CAFP’s Payment Reform Primer
CAFP promises to keep you well informed and provide education on how to navigate the new environment. We will help to mitigate potential problems for solo practices and advise on avoiding the pitfalls of narrow networks. With the launch of CAFP’s Payment Reform Primer, with contributions from various stakeholders, we will see to it that family physicians are rewarded for high quality care.
Be Ahead of the Curve
In late March 2015, HHS launched its’ Health Care Payment Learning and Action Network (Network) to facilitate discussions between both the private and public sector of healthcare. The Network will serve as a forum and will work to develop best practices on how to appropriately transition to value based care and to disseminate all information. CAFP encourages you to register online to be part of the Network.
Payment for Care Management Services
Value-based payment is only one type of change. Another important development is payment for care management services. In January 2015, CMS began paying primary care physicians for care management of patients with multiple chronic illnesses. The New England Journal of Medicine described this as “the most important broadly applicable change [CMS] has made to primary care payment to date."
CAFP held a free, online webinar for our members addressing small and solo practice concerns regarding how to build care management plans while complying with new Medicare requirements. Individuals will need an email address to view the online video.