Universal Benefits of Value Based Care

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Universal Benefits of Value Based Care

TL;DR

  • Value-based care is a potentially viable payment model for practices, regardless of MACRA participation
  • The Healthcare Information and Management Systems Society (HIMSS) and the Department of Health and Human Services (HHS) are focusing on small and rural practices in preparation for MACRA
  • HIMSS submitted a Comment Letter detailing their concerns and recommendations for MACRA
  • The HHS is providing $100 million dollars in total to educate and train small practices for MACRA

Value-based care is slowly encroaching on the traditional fee-for-service as a viable payment model. It has seen support from both government and health IT organizations as an effective way to treat patients. However, transitioning to value-based care can be a challenging task, especially for small practices.

Small practices deal with a limited amount of resources and treat a proportionately large amount of patients to staff. They face increased financial and organizational burden when managing care. In light of this, the Healthcare Information and Management Systems Society (HIMSS) and the Department of Health and Human Services (HHS) have voiced their support in helping small practices overcome logistical hurdles, and prepare for the upcoming value-based Medicare program MACRA. Take a look at the efficacy of value-based care as a payment model, and how the HIMSS and HHS are focusing their attention on small practices.

Is Value-based Care Good for Everyone?

Value-based care has seen increased traction because it emphasizes the quality of care while reducing cost. For providers, value-based care leads to more efficient patient cycles. Patients receive treatments focused on their health and safety, leaving them happy, giving  providers the opportunity to see more patients in the long run. An effective value-based care system takes measurements across the board, such as prescription adherement and percentage of readmission, to provide treatment that is cost-effective. Providers who enroll in value-based care with Accountable Care Organizations (ACOs) recieve financial incentives for quality patient cycles.

HIMSS Submits Comment Letter on MACRA Proposed Rule

In a letter to the Center for Medicare and Medicaid Services (CMS), HIMSS offered its comments on MACRA. While HIMSS noted the “effort to shift Medicare Part B to a value-based payment system…while allowing the opportunity for customization, streamlined requirements, and flexibility”, they acknowledged that this may add a level of complexity and burden on eligible clinicians (EC). In particular, HIMSS asks the CMS to “redouble its efforts in educating the clinician community on new MACRA requirements, and ensure that the burden placed on individual and small practices is not too pronounced.”

Massive programs like MACRA require dedicated time and resources to adequately handle.  By HIMSS acknowledging the burdens small practices face, they recognize the challenge of practicing in sub-par conditions.

HHS Providing $100 Million Dollar Funding to Help Small Practices

Because participating in in extensive government programs like MACRA can be a daunting task, the HHS is providing funding for small practices that are looking to learn more and train their staff on MACRA.

“Doctors and health care providers in small and rural practices are critical to our goal of building a health care system that works for everyone,” said Secretary Burwell. “Supporting local health care providers with the resources and information necessary for them to provide quality care is a top priority for this administration.”

The HHS will continue to award $20 million each year over the next five years, providing $100 million in total to help small practices successfully participate in the Quality Payment Program, and, most importantly, “will provide education and consultation about the Quality Payment Program at no cost to the clinician or their practice.”

As with any new implementation of technology, time and resources are required to get staff up to speed. By providing funding, practices who have never considered or may be on the fence about MACRA, may be more encouraged to participate.

Should You Participate in MACRA?

It’s important to be aware of the challenges small practices face, regardless of MACRA participation. Deciding to sign up for MACRA depends on whether or not you qualify, and if you have the resources available to capitalize on the benefits. To go over the benefits, MACRA is split up into two parts: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). With MIPS, a provider’s Medicare Part B payment plan will be negatively or positively adjusted, depending on their composite reporting score. By signing up for an APM, providers may receive rewards based on their payment model, such as lump sum bonuses at the end of the year.

Value-based care will continue to receive support because it emphasizes a treatment model based on the patient. Healthier patients means happier patients, which is good for everyone.

The HIMSS comment letter and the HHS funding are steps in adopting value-based healthcare for America. Support for value-based care has been industry-wide as well as political, and continues to grow with MACRA. We look at MACRA as a step towards value-based healthcare, and we continue to transform our EHR into one that adapts to the change.

PrognoCIS emphasizes efficiency and productivity in the workplace, and strives to adapt to what’s best for the provider. For more information, here is our break down of MACRA and our analysis of fee-for-service vs. capitation. PrognoCIS currently supports Meaningful Use Attestation to its final Stage 3, and plans to continue support for MACRA and beyond.

Picture from Flickr by the DFID

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