As part of healthcare’s historic shift from fee-for-service to value-based reimbursement, the Centers for Medicare & Medicaid Services (CMS) has implemented three programs to reward quality and efficiency: the Physician Quality Reporting System (PQRS), the Value-Based Modifier Program (VM), and the Electronic Health Records (EHR) Incentive Program, more commonly known as Meaningful Use (MU).
The details of these programs can be confusing, with each having unique deadlines, phases, and reporting requirements. However, the financial stakes are high. For example, a physician who does not master these programs is at risk of losing nearly 10% of his or her Medicare payments by 2017. Just as importantly, a physician’s reputation is publicly exposed as individual performance on quality metrics will soon be made publicly available to patients. It is crucial for physicians to develop a strategic plan to achieve success in the current healthcare environment and be better poised for the future.
How PYA can Help:
Looking Ahead …
Starting in 2019, CMS will roll out a “new and improved” program known as the Merit-Based Incentive Payment System (MIPS). MIPS will replace the existing programs, incorporating all the same concepts under one umbrella – but with higher financial stakes.
The Time to Act is Now…
Having a solid foundation and strategic plan in place for value-based reimbursement, including PQRS, VM, and MU positions providers to avoid penalties today and to be on the bonus side of MIPS in the future. While quality programs have been in place for several years, the financial and reputational stakes are increasing in significance. PYA recommends planning for success through the implementation of a tactical plan that will streamline and better align operations in a way that supports quality reporting of care delivery. The ultimate goal is to avoid costly penalties and potentially earn incentive payments.
For more information on value-based tactical planning, contact one of the experts listed below at PYA (888) 420-9876.
