Transitioning Medicare from fee-for-service (FFS) payments to value-based reimbursement

Transitioning Medicare from fee-for-service (FFS) payments to value-based reimbursement

The shift from fee-for-service to fee-for-value necessitates that hospitals and physicians optimize their operations and align costs with clinical outcomes. Especially challenging is controlling the medical/surgical expense and increasing patient throughput without sacrificing quality of care. But you’ll need to look beyond the price of supplies to maintain margins and stay competitive.

In the current fee-for-service model of reimbursing providers for health care, physicians and organizations have incentives to 'do" more. The more tests you order, patients you see, procedures you do, the more money you will make,  their payments are now based on the value of care they deliver (value-based care).

CMS made a bold announcement in January 2015: It plans to ramp up its timeline for transitioning Medicare from fee-for-service (FFS) payments to value-based reimbursement. For the first time, CMS is being incredibly specific about its timeline and methodology. It plans to take the following two actions:

•30 percent of payments will be tied to alternative payment ACO or bundled payment arrangements by the end of 2016. Payments related to these models will increase to 50 percent by the end of 2018.

•85 percent of all traditional Medicare payments will be tied to quality or value by 2016 and 90 percent by 2018 through programs such as Hospital Value Based Purchasing and Hospital Readmissions Reduction.

At about the same time, on the commercial front, a group of payers, patients, providers, and purchasers formed a value-based coalition with similarly aggressive goals. The coalition, which includes Aetna, Blue Cross, Health Care Services Corporation, Ascension Health, and Trinity Health, stated that 75 percent of their respective businesses would be operating under value-based payments by 2020.

Are you ready ?

Payers — primarily Medicare — are putting their money where their mouth is and starting to recognize and reward work that’s been proven to improve the quality of care and help keep long-term costs down.  Patients are gaining greater access to care. And providers now have more ways to get paid for the care they provide, with increased flexibility in how they’re providing that care. 

Transition

Making this transformation is not a single step but an overarching strategy. Knowing the plan proposed by CMS, the time is NOW to prepare, organize and decide how to convert to value-based reimbursement.

 

HPP AccuChecker is helping providers improve their understanding of what outcomes to measure and how to collect, analyze, and report outcomes data.  Health outcomes is data driven by: 

·         PQRS

·         HEDIS

·         National Quality Measures

·         Meaningful Use

·         Core Measures 

Financial outcome is determined on how the Risk is determined and how is controlled. 

85 percent of all traditional Medicare payments will be tied to quality or value by 2016 and 90 percent by 2018 

Avoid the penalties and/or reductions.

 

Call us for details.

 

 

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800

Miami, FL 33126

Phone: (305) 227-2383

Email: psilben@hppcorp.com

Website: http://www.accuchecker.com