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Change in CMS primary-care program seen scaring away some providers

Video: How small practices can survive changed healthcare world


In this video,  Halee S. Fischer-Wright, president and CEO of the Medical Group Management Association (MGMA),  discusses how small medical practices can survive now that  the environment for running medical practices a decade ago “no longer applies.”  She calls for physician owners to be more involved in the business side  of their practice.

To see the  Physicians Practice video, please hit this link.

Few provider groups benefited from CMS’s value-based payment program


Data from the Centers for Medicare & Medicaid Services show that few provider practices benefited from the agency’s Value-Based Payment Modifier program.

13,813 physician groups were eligible to compete for the pay bump, but only 128 group practices will see their Medicare reimbursement rise by 16 percent or 32 percent, with the higher percentage going to practices with the most high-risk patients.

The fact that so few practices benefit from VBM could indicate an inherent flaw in the program’s methodology, Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, told Modern Healthcare.

“These results show that getting a reimbursement increase is akin to winning the lottery. This just isn’t a meaningful system.”

Quality-metric reporting seen as too costly and often waste of time


A study in HealthAffairs suggests that lot of reporting on quality metrics by physicians is a costly waste of time.

The study found that  12.5 hours of physician and staff time per physician per week was spent on entering information into the medical record solely to report for quality measures from external entities.

“There is much to gain from quality measurement, but the current system is far from being efficient and contributes to negative physician attitudes toward quality measures,” the authors wrote.

Halee Fischer-Wright, M.D., president and CEO of the Medical Group Management Association, said of the  research:  “This study proves that the current top-down approach has failed. It serves no purpose to have over 3,000 competing measures of quality across government and private initiatives. Although standardization is critical, if measures don’t improve patient care, it’s an exercise in futility. As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country.”


MIPS looms, but maybe you can opt out


Providers are girding their loins to comply not only  with the next stage of the Meaningful Use program, but also a  new mandated electronic reporting requirement: Medicare’s Merit-based Incentive Payment System (MIPS).

The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use and clinical-practice improvement.

Robert Tennant, senior policy adviser with the Medical Group Management Association (MGMA),  told MedPage Today that the two programs are very inter-twined:
“Even though Meaningful Use was sunsetted, it’s now effectively 25% of your MIPS score, so it never really goes away.” And because it is so much of the MIPS score, “it’s potentially more impactful on your reimbursement.”

But Linda Delo, D.O., a family physician in Port Saint Lucie, Fla., told the online news service that, as MedPage paraphrased her, “{P]hysicians can get out from under MIPS in some cases if they become part of an alternative payment model such as an Accountable Care Organization (ACO), a bundled payment model, or a patient-centered medical home (PCMH), rather than continue in the traditional fee-for-service Medicare program.”


Big trouble seems to loom with ICD-10


Medscape reports that almost 25 percent  of  physicians’ offices said in a survey they won’t be ready when the new, more complex International Classification of Diseases, 10th edition (ICD-10),  arrives Oct. 1.  Another 25 percent said  that they weren’t  sure if  they’d  be ready.

“The latest Workgroup for Electronic Data Interchange (WEDI) survey also found that only about 20 percent of physician practices have started or completed external testing. That percentage is up from the 10 percent of physicians who said they had done external testing in results released in March.”

Robert Tennant, vice chairman of the WEDI group and government affairs senior policy adviser for the Medical Group Management Association,  told Medscape that the survey indicates  big trouble.

“The physician side of the provider community — they’re really struggling,” Tennant said. “I think the government has not done a very good job about explaining the return on investment for physicians; it’s not clear at all why we’re doing this.”

“Also, many are at the mercy of their software vendors,” he said, noting  that if the software isn’t up to date, physicians can’t submit the codes or test the systems.

“What that tells us in the industry is that we’re looking at potentially a situation, where the light switch is flipped and things don’t work,” he said.




PCP pay rising faster than other physicians’

The Medical Group Management Association says that that primary-care physician compensation is rising faster than other  specialists’. (Wed call a primary-care physicians a specialists in being generalists.)

Still,  those specialists earn nearly twice as much.

Primary-care physicians reported a median compensation of $241,273 in 2014, up 3.56 percent from 2013. Median compensation for other physicians  rose to $411,852, up  2.39 percent.

(The median household income in the U.S. is about $50,000.)

“The role of the primary-care physician continues to be a linchpin with the new healthcare models,” Todd Evenson, MGMA chief operating officer, told MedPage Today.  “Obviously hospitals are playing a role hiring at a brisk pace, strengthening their referral networks and trying to ensure that they can deliver on a quality-based model.”

He also said:

“In 2012 our survey showed on average that 6.67 percent of compensation for primary-care physicians was based on quality measures. In 2014 that had already migrated to 10.83 percent  for primary care. On the specialty side, it was 4.6 percent in 2013 and 7.3 percent in 2014. This clearly indicates that the quality component is becoming a larger factor.”

In 2012 50 percent of  respondents said that their compensation was 100 percent productivity-based (i.e., “fee for service”). But in 2014 only 25 percent  of respondents said their pay was totally fee for service..”That shift is pretty sizable in terms of the composition of these compensation plans aligning with value measures, and reflects what is going on in these reimbursement models,”  Mr. Everson said.





Video: What Burwell vs. King could mean for physician practices


In this video, Anders M. Gilberg, senior vice president for government affairs of the Medical Group Management Association (MGMA), looks what a decision invalidating health-insurance subsidies would mean for medical practices. He also offers advice to practices on what they can do—regardless of the King vs. Burwell decision—to ensure that they are paid for seeing patients, whatever the patient’s insurance coverage.

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