Value Based Healthcare: Get Some Answers

I have an “email subscription” to the TED lecture series.  Each day I receive a notice with a link to a new video lecture that has been posted.  Some days, especially the very busy ones, I don’t even open the email.  If I do not perceive the title to be worthy of the 15-20 minutes of my time, I immediately delete it.  One title struck me as extremely worthy, I took the time to listen, and ta da here I am writing this post.

My inspiration was this lecture byphysicianStefan Larsson: What doctors can learn from each other.
Hopefully you have time to watch this lecture.  Anyone in the US healthcare industry should.  We Americans typically think we have cornered the market on being the best at everything.  Sometimes we need to be reminded we are not and even if you are the best, there is almost always room for improvement.  The improvement needed, which is pointed out so eloquently in this lecture is the idea that value based medical healthcare works!

questions about value based healthcareThe following 5 questions and answers will provide a brief primer on value based healthcare.

What does value based healthcare mean?  It is a relatively simple concept.  By switching the focus to the best patient care, costs are typically reduced in the long run, providing the highest “value” for the service. 
Think about when you buy a new TV.  You can get the “generic” brand for half the price of a “name” brand, but it lasts 2 years and the name brand lasts 5.  There is more value in the “name” brand. 
Who will be impacted by this new payment model?  The Affordable Care Act requires CMS to establish a value-based payment modifier that provides for differential payment to a physician or group of physicians under the PFS based upon the quality of care furnished to Medicare beneficiaries compared to the cost of that care during a performance period. 
For CY 2015 groups of physicians with 100 or more eligible professionals are subject to the value-based payment modifier.  The limit will be significantly reduced in CY 2016 to groups of physicians with 10 or more eligible professionals.  
It is estimated that this lowered threshold will cause approximately 17,000 groups and nearly 60 percent of physicians to be included in the value-based payment modifier program in CY 2016. (Groups of physicians with 100 or more eligible professionals could receive either upward or downward adjustments.  However, only upward adjustments will be applied to groups of physicians with between 10 and 99 eligible professionals.)
Commercial payers are also creating processes and protocols to follow suit with implementing value based healthcare. 
Where will the data come from?  CMS collects and analyzes data via the PQRS program.  
A recent survey published by Availity™, shows that commercial payers as well as providers have growing concerns over the ability to exchange the necessary health information in an automated fashion. 
How will the value of the care be measured? Current plans include utilizing data collected via PQRS performance.  The Medicare Spending per Beneficiary (MSPB) measure may be included as an additional measure in the cost composite of the value-based payment modifier beginning with CY 2016.
When should I expect this to occur?  Part of theACA statute requires that CMS begins applying the value-based payment modifier on January 1, 2015, with respect to items and services furnished by specific physicians and groups of physicians (as determined by the Secretary) and to apply it to all physicians and groups of physicians beginning not later than Jan. 1, 2017.  

CMS websiteThe CMS website provides more extensive information on the Physician Value-based Payment Modifier.