CMS’s Quality Payment Program (QPP), which went live with the 2015 enactment of the Medicare Access and CHIP Reauthorization Act (MACRA), represents the biggest single development in U.S. healthcare since President Lyndon Johnson signed Medicare and Medicaid into law in 1965.
That’s according to Cristine Vogel, MPH, a senior consultant with Connecticut-based VantagePoint HealthCare Advisors, who fleshed out some radiology-specific MACRA details in a regional AHRA meeting April 5 at Middlesex Hospital in Middletown, Conn.
“I have read the entire law and all the comments to it, and this is my free advice: Begin reporting [quality measures] as soon as possible,” Vogel said.
Noting the QPP’s aggressive timeline—HHS wants to have CMS reimburse 50 percent of Medicare claims through value-based pathways such as MIPS and Advanced Alternative Payment Models (APMs) by 2018—Vogel pointed out that the commercial-insurance industry’s Healthcare Transformation Task Force is following suit, aiming for 75 percent value-based payments by 2020.
Value-based healthcare “really means looking at how you are providing care to your patients and trying to add value not only to the patient—which is very important—but also to your bottom line,” Vogel said.
Because most providers’ contracts with payers will be value-based, money will increasingly be at risk. “You are not just going to get reimbursed from Aetna and Cigna and Anthem,” Vogel said. “You are going to be working with the payer, whether it is CMS or an insurance company, at a contractual level, trying to figure out how you can deliver better value to your patients.”
Over time, the Quality Payment Program will be the one quality-based payment program for the entire U.S. healthcare system. “This is actually a good thing, because right now we have so many going on and we complain about that all the time,” Vogel said. “Under MACRA, CMS has actually listened.”
Vogel offered several questions for radiology practices and departments to consider as they move into the MACRA/QPP era: How will consolidation impact your practice? How are your competitors reacting, and what effect will this have on your practice? How can your practice be an attractive partner, and what is your value proposition?
She also suggested five steps rad practices can take en route to pursuing success under MACRA:
- Fully leverage technology, care coordination and data analytics.
- Provide education and training to your workforce so they understand their role in your value-based payment model.
- Refocus your patient engagement strategy to be more patient-focused and technically responsive.
- Review your clinical documentation and ensure you are optimizing your coding.
- Align your practice with the care continuum and move away from the volume-driven system.
“Don’t leave the money down in Washington, D.C.,” Vogel said, referring to the QPP’s funding of bonuses for high performers with monies drawn from penalties assessed to low achievers. “Because this is graded on a scale, those high achievers will have even more money if you leave it on the table. There is this box of money down there, and they are saying, ‘This is what we have to give out.’ You really want to make sure you are maximizing your score.”
Resources abound to help radiology succeed with the QPP. Click here for guidance from the American College of Radiology, here for helps from the Society of Interventional Radiology and here for HHS’s own user-friendly QPP website.