4/24/2017 PHYSICIAN ENGAGEMENT IN A VALUE-BASED REIMBURSEMENT ENVIRONMENT THROUGH COMPENSATION DESIGN April 25, 2017 Zach Remmich David Stein, M.D. Managing Consultant President zremmich@bkd.com Strategic Medical Consultants 1
4/24/2017 TO RECEIVE CPE CREDIT • Participate in entire webinar • Answer polls when they are provided • If you are viewing this webinar in a group Complete group attendance form with • Title & date of live webinar • Your company name • Your printed name, signature & email address All group attendance sheets must be submitted to training@bkd.com within 24 hours of live webinar Answer polls when they are provided • If all eligibility requirements are met, each participant will be emailed their CPE certificates within 15 business days of live webinar AGENDA • Brief Recap of Value-Based Reimbursement • Brief Recap of MACRA • Aligning Quality & Cost Goals to Physician Compensation • MACRA Application • Compensation Change Management Process Overview 2
4/24/2017 CMS SHIFT PAYMENT AWAY FROM FEE-FOR-SERVICE All Medicare FFS (categories 1–4) 85% FFS linked to quality (categories 2–4) Alternative payment models (categories 3–4) 2016 2018 30% 50% 85% %06 All Medicare FFS All Medicare FFS Source: www.cms.gov “Better Care. Smarter Spending. Healthier People. Paying Providers for Value, Not Volume.” HOW WILL YOU BE REIMBURSED? CMS wants 50% of payments to come through these mechanisms by 2018 Pay-for-“Value” FFS APMs Population Health (Historical) (MACRA) (CPC+) (Single payor models) FFS Payment Savings earned Savings earned adjustment Keep cost low FFS CMF & quality Revenue PMPM FFS Increase volume Incentivizes to maximize volume revenue FFS Additional Cost to implement Cost to implement Cost to implement Costs & report quality & maintain & maintain Illustrative Examples Only 3
4/24/2017 KEY TAKEAWAYS KEY TAKEAWAYS • Move away from transactional fee-for-service & shift toward quality & cost management of beneficiaries 4
4/24/2017 KEY TAKEAWAYS • Emphasis on data analytics, provider documentation & patient panel management • Care coordination & population health management more the focus KEY TAKEAWAYS • Commercial carriers rapidly following in the footsteps of CMS • Publication of outcomes data proliferating – increased financial responsibility by patients for their care 5
4/24/2017 ENGAGEMENT OF SMALL & LARGE GROUPS UNDER VB REIMBURSEMENT • Internal dynamics vary drastically across practice sizes • Understanding expertise & capabilities to manage VB aspects within the practice is for key long-term planning & success Brief Recap of MACRA 6
4/24/2017 MACRA AT A GLANCE • Eliminate sustainable growth rate (“doc fix”) • Creates two new physician payment models CMS Quality Payment Program MIPS – fee-for-service tied to performance – Medicare Part B payments (“pick your pace” for year one) Merit-Based Incentive Payment APMs – payment models that reward providers System (MIPS) for cost & outcomes Advanced “Test” “Partial” “Full” • Consolidates financial impacts of current Alternative Reporting Reporting Reporting Payment reporting programs (PQRS, VBPM & MU) Report Report Report full Models some data partial year year & earn • Emphasis on performance vs. pay-for- (APMs) & avoid & earn max reporting negative small adjustment payment payment & potential • Program incentives intend to steer physician adjustment adjustment bonus participation in APMs GENERAL MIPS OVERVIEW Year Quality Cost Advancing Care Improvement Information Activities Composite 2017 60% 0% 25% 15% Performance Score (CPS) 2018 50% 10% 25% 15% 2019 + 30% 30% 25% 15% • Replaces VBPM cost • Replaces PQRS • Replaces MU • New category component • 200 measures – • Moves away from • >90 activities to • Included in 2018 specialty emphasis “all or nothing” choose from performance year • Bonus points • Certain exemptions • 90 consecutive days • Based on claims data available • Can report as a • Preferential scoring • 10 disease groups group • Refining attribution methodology 7
4/24/2017 GENERAL APM OVERVIEW Advanced APM qualifications • Require participants to use certified EHR technology • Base payments for services on quality measures comparable to those in MIPS • Require participants to bear more than nominal financial risk for losses • 8% of estimated average total Medicare Parts A & B revenues of participating APM entities must be at risk; OR • Maximum loss must be 3% of expected expenditures for which APM Entity is responsible under APM GENERAL APM OVERVIEW Qualifying participant requirements • Eligible clinicians (EP) must meet payment or patient thresholds to be considered a qualifying participant (QP) • EPs must be included on a participation list on one of three days – March 31, June 30 or August 31 8
4/24/2017 REIMBURSEMENT IMPLICATIONS – WHAT’S AT RISK 2017 2018 2019 2020 2021 2022 + 2026+ Fee Schedule APM: 0.75% 0.5% Update 0.0% Update Update MIPS: 0.25% 27% 21% 15% Budget Neutral 12% Scaling Factor 3x Max MPFS Base Rate Adj -4.0% -5.0% -7.0% -9.0% APM 5% Annual Bonus Aligning Quality & Cost Goals to Physician Compensation Models: Employment, Gainsharing or Purely Collaborative 9
4/24/2017 COMPOSITION OF PHYSICIAN COMPENSATION PLANS QUALITY INCLUDED IN ANTICIPATE MODIFYING BALANCE COMPENSATION PLAN FOR EMPLOYED BETWEEN PRODUCTIVITY-BASED & PHYSICIANS QUALITY-BASED PAY Anticipate Modifications 34% Not Included Included 47% 53% Do Not Anticipate Modifications 66% Source: Sullivan, Cotter & Associates, Inc. (2016). Physician Compensation & Productivity Survey Report ENGAGING PHYSICIANS EARLY ON IN THE PROCESS • Builds trust in the process & data • Transparency & education around the data is essential • Seek input on metrics relevant to their clinical practices that align with VB reporting programs 10
4/24/2017 SELECTING VALUE-BASED METRICS FOR COMPENSATION DESIGN • Start small – try not to tackle your entire quality program within incentive compensation metrics • Allow for flexibility – you should include a combination of process & outcome metrics • Reward progress – this will show that the organization values the provider’s effort • Involve physicians – physician involvement is critical • Promote communication & teamwork – goal is fostering collaboration QUALITY METRICS – NOT ONE-SIZE-FITS-ALL • Quality metrics don’t always fit well for all provider types, so it is necessary to identify what will & will not work best for each provider group PCPs Specialists – Ortho Quality Metrics • Cancer screening • Identification of Implanted • Controlling high blood pressure Prosthesis in Operative Report • Depression readmission • Cardiovascular risk evaluation, e.g. , total knee replacement patients Cost/Operations • Panel size • Implant costs Metrics • Chronic disease management • Transition of care protocols • Beneficiary direct costs • Discharge disposition (home, home health, SNF) 11
4/24/2017 REWARDING PROCESS & OUTCOMES Operational Metric Example Process Metric Outcome THA Pathway Developed Percentage of Incentive Compliance with THA Percentage of Incentive & Approved Compensation Earned Pathway (% of Cases) Compensation Earned Pathway not 0% > 80% but less than 85% 25% developed/approved > 8 months < 12 months 25% > 85% but less than 90% 50% > 7 months < 8 months 50% > 90% but less than 95% 75% > 6 months < 7 months 75% > 95% 100% < 6 months 100% WHAT DO THESE PLANS LOOK LIKE – EXAMPLES Element of Comp Plan Current Composition Future Composition 4,928 * wRVUs Productivity Panel of 2,500 patients Compensation Rate $45.00 per wRVU N/A Productivity-Based Compensation $221,760 N/A Guaranteed Salary $0 $155,456 Incentive-Based Compensation $8,696 $60,000 Service Quality $3,696 $10,000 Clinical Quality $5,000 $50,000 PPPM Management Fee N/A $6 PMPY (6 x 2500) = 15,000 Total Compensation * $230,456 $230,456 * Based on 2016 MGMA median for family medicine (without OB) 12
4/24/2017 KEY TAKEAWAYS • Aligning physicians with your organization can seem like a daunting task, but there are a number of strategies you can use to enhance engagement around quality & cost • Start with a manageable program & allow for flexibility along the way. Your plan should allow for change & updates as you identify areas of success & failures 13
4/24/2017 KEY TAKEAWAYS • Approach the metric selection process strategically. Identify what aligns with organizational objectives & makes sense for you providers (PCP vs. specialty) KEY TAKEAWAYS • Identify what metrics are used under value-based reimbursement programs & select metrics that align with what is being used to assess reimbursement • Select metrics from a variety of categories to allow for a more robust performance analysis 14
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