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Independence vs. Employment for Physicians

Posted by Continuum on Mar 21, 2017 11:01:00 AM

Is employment really the answer?

Hospital employment, with its promises of financial security, fewer administrative duties, and more stable working hours offer a strong case for physicians.  From 2007 to 2016, the number of independent physicians has decreased by 28 percent.1,2 Many physicians have opted for employment within a large health organization because it appears more appealing than fighting to maintain an independent practice; but the number of physicians pushing for independence may be on the rise.

This shift is being triggered as physicians find those promises aren’t always grounded in reality. Physicians feel that an employed position will require less administrative tasks and thereby provide more time to spend with patients. Yet administrative duties are inescapable. Most physicians are still required to maintain quality of care reporting and accurate EHR entries, whether they are independent or employed.

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Topics: independent physician, hospital employment, independent physician practice

New Medicare reporting requirements: MACRA, MIPS & APMs Key Dates & Deadlines

Posted by Continuum on Feb 28, 2017 11:00:00 AM

As many physicians are aware, major changes are underway in how Medicare will reimburse them. The Centers for Medicare and Medicaid Services (CMS) is phasing in new reporting requirements focusing on “value” of care: measures of quality, overall cost of care, and patient satisfaction. Increasingly, how doctors address these new requirements will directly affect their reimbursement – potentially leading to financial rewards or penalties. Moreover, commercial payers are starting to follow Medicare’s lead. 

Here’s a quick refresher on the basics, including important dates for most physicians who see Medicare patients:  

  • The Medicare Access & CHIP Authorization Act (MACRA) of 2015 requires doctors to choose a reporting path – either the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (Advanced APM).
  • MIPS is comprised of Quality, Improvement Activities, Advancing Care Information, and Cost. MIPS payment adjustments will start at +/-4% for the 2017 reporting year (2019 payment year) and increase over time. (Cost will not affect payment adjustments until 2018).
  • Advanced APMs offer higher financial incentives than the MIPS track, but require more advanced levels of value-based activities. APMs also require physicians to be part of a larger group, such as an accountable care organization (ACO) or medical home, and to bear greater financial risk.
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Topics: MACRA, MIPS, APMs

The Rise of the Narrow Network

Posted by Continuum on Feb 21, 2017 10:30:00 AM

Despite helping reduce costs, are narrow networks the true way of the future?

It's time for a change. As limited provider choice in exchanges rises, and the need to track quality across the patient’s care delivery continuum creates a bigger impact on providers’ bottom lines, practices will need to find means to protect their revenue. This is forcing more and more provider organizations to develop preferred partner lists—another way of saying narrow networks.

There are two key groups impacted by this shift, and they seem to have different feelings about the pros and cons of narrow networks.  

  •  Patient benefits: The healthcare industry can expect to see more narrowing as time goes on. This is, in part, thanks to the benefits to healthcare consumers. Narrow networks offer cheaper premiums—on average, those premiums are 17 percent less than plans with broader networks.[i] In fact, nearly 70 percent of the lowest priced plans are built around narrow networks, ultra narrow networks, and tiered narrow networks.[ii] The downside, though, is higher prices for out-of-network costs—which were, on average, 300 percent higher than the average Medicare rates for 97 common medical procedures.[iii]
  •  Provider concerns: This trend is causing some anxiety amongst providers, and for a couple of different reasons. Providers’ ability to retain their patients may be challenged if their system of narrow networks is not clearly defined. In addition, providers may not have a clear understanding of how their participation or performance will be measured—or what may cause them not to be invited to participate in an ultra-narrow network.
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Topics: narrow network, healthcare exchanges

Hitting the Trails: Take a guide on your value-based care journey

Posted by Continuum on Jan 10, 2017 11:00:00 AM

The healthcare payment landscape seems to change every week. Developing a strategy for success is nearly as tough as assessing what alternative payment model (APM) programs you should pursue. Is there a benefit to staying focused on
fee-for-service? Are pay-for-performance models the right path for your organization? How much risk is too much risk for you?New Call-to-action

The good news is there’s no one path to value-based care success. The various programs offer different benefits to healthcare organizations of all types. Understanding the full ecosystem of programs available to you is critical to make sure you start your journey to future success on the right path.

As with any journey, keeping a guide handy is a smart plan. Continuum’s value-based payment experts have developed a new reference to help you make sure you’re on the right track. This infographic, “The Trail Guide to Value-Based Care Success,” offers key insights and reminders about the benefits for various payment programs, common challenges, and tips for making the most of your participation.

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Topics: value-based reimbursement, payment reform

Five Essential Population Health Management Tips

Posted by Continuum on Dec 6, 2016 10:30:00 AM

Success in VBC initiatives depends on smart pop health strategies

Population Health Management (PHM) is the buzzword of the moment when it comes to success in value-based care initiatives. There’s a good reason for that – done right, PHM has a strong chance of helping providers realize the goals of the triple aim and generate real revenue to reinvest in their organizations.

Don’t let all of the buzz distract you from reality. As we’ve learned from watching Big Data’s hype cycle, it’s important to focus on how you can make PHM work most effectively for you. It’s becoming clear that simply purchasing a PHM solution isn’t the silver bullet that’s going to deliver success.

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Topics: population health management, Value-Based Healthcare, Practice Transformation, PHM

MACRA Final Rule: 4 Key Changes

Posted by Continuum on Nov 15, 2016 11:15:00 AM

The Centers for Medicare & Medicaid Services (CMS) recently released its final rule for sweeping reimbursement regulations that start on Jan. 1, 2017.
Known as MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), this legislation will have a profound impact on physicians and their practices.

On the plus side, the final rule softens some of the proposed regulations. This easing should help providers comply and thereby support CMS’s goals: to enhance care quality, reduce overall costs of care, and improve patient satisfaction. The best-performing providers will receive the greatest payment increases.

At the same time, eligible Medicare providers who have not yet prepared for MACRA should move quickly. Those who ignore the new reporting requirements completely -- by not submitting data to CMS -- will receive the full 4% payment penalty for 2017, and greater reductions thereafter.

MACRA establishes the Quality Payment Program (QPP), which offers providers a choice between two reporting tracks: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Model (Advanced APM).

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Topics: MACRA

The medical home model: What physicians need to know

Posted by Continuum on Nov 1, 2016 1:08:19 PM

The concept of a “medical home” has evolved over the years, starting in the 1960s as the center of medical records for a child with special healthcare needs. Today, that definition is greatly expanded: A medical home is a partnership between the patient, family and primary care provider, in cooperation with specialists and community supports, according to the U.S. Department of Health and Human Services. It can encompass children and adults, regardless of their healthcare needs.

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Topics: APMs, Value-Based Healthcare, MIPS

Do you have what it takes to thrive as an independent physician?

Posted by Continuum on Aug 30, 2016 2:00:00 PM

Fortune favors the bold

The primary care market is shifting. Shifting regulations and evolving payment models are shaking the foundations of traditional independent primary care practices—and these market forces are even stronger than new and old competitors. As the CEO of a physician practice in Maryland recently told us:

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Topics: ACO, CIN, independent physician practice

Medicare Quality Data: Who Must Report?

Posted by Continuum on Aug 16, 2016 11:00:00 AM

Starting next year, most doctors will be required to report quality data under Medicare’s new Merit-Based Incentive Payment System (MIPS). MIPS will apply to other clinicians, too, such as physician assistants and nurse practitioners. However, many thousands of practitioners will be exempt from these requirements, if they meet certain criteria.

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Topics: Alternative Payment Models, APMs, MIPS, value-based reimbursement

Five ways to balance the cost side of the VBM equation

Posted by Continuum on Aug 2, 2016 11:00:00 AM

Continuum’s recent white paper, “How Physicians Can Win in the New Healthcare Environment,” explored several key strategies on how to transform the physician practice to capitalize on healthcare reform initiatives. In that paper, we examined five ways to maximize the value-based payment modifier adjustment, primarily from a quality perspective.

There’s another dimension to the quality improvement that value-based care aims for: there’s the means to reduce cost. Not just the cost to your practice, it’s the total cost of care. Here are five key methods to help reduce high costs in the value-based care world.

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Topics: Value-Based Modifer

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