This includes things like: What measures are you going to report on? And how are you going to report performance on those measures? If using one of the electronic registries, there are more measures to choose from and a greater likelihood of success. But, of course, these registries have associated technical barriers and costs. And recall, in the MIPS program, those that fall below the performance threshold pay a penalty and those that fall above get a bonus; said differently, the losers pay the winners.
These are all crucial questions that must be answered and much has already been written on them. Going beyond these necessary details, we offer three “secrets” to success as a physician or group organizes their own practice around this evolving payment system transition.
Diversity Matters: A multi-disciplinary team approach is essential. It’s helpful to have a revenue cycle management group that is made up of an administrative leader in healthcare finance with deep experience in billing collections and payor contracting who can help navigate technical complexities. This kind of knowledge and expertise is crucial as practices plan their strategy. However, it’s just as important to have involvement of physician leaders. It is one thing to analyze data on spreadsheets and read CMS comment letters; it’s quite another to work on the frontlines of patient care and understand what is realistic. It is this cooperation at the blunt end and the sharp end of care that allows for the greatest impact.
Do Your Part Locally and Nationally: When it comes to payors, Medicare is the biggest payor impacting patient care nationally. Changing how they function, through comment letters and societal channels, is a necessary part of system development. Additionally, practices must devote resources to making value-based quality advances with local payors. For example, our practice developed a program to improve management on incidentally discovered thyroid nodules. Such nodules are quite common and mismanagement can lead to unnecessary imaging, biopsies and even surgery. All with added (and unnecessary) expenses and the very real risk of complications. The goal of this, and similar programs, is to improve patient care and simultaneously limit waste of resources for the entire healthcare system. So, instead of only trying to move the national payor, Medicare, we also went to a payor in Ohio and negotiated a local deal. They will pay us more based on documented adherence to this best practice program. It saves them money and is better for patient care. Additional local programs will follow.
Do the Right Thing: The truth is that much of healthcare, including much of radiology, is still volume driven. Yes, there is a transition to value but most payments are still transactional. Do a head CT scan and get paid for a head CT scan. More scans equate to more revenue, even if the dollar value per scan is reduced. What is a practice to do? If you opt for true value-based payment in a fee-for-service world, you do so at your own risk. Those “savings” may come from your pocket. So, what is the optimal balance between value and volume? The answer: Do what’s best for the patient. It’s easy to fall into the trap of misaligned incentives. A consistent patient-first policy will establish credibility with payors. More importantly, it’s the right thing to do and the reason we got into healthcare in the first place.
Our country is transitioning from volume to value. Navigating these waters is challenging and risk-filled, but a necessary part of the new reality. The prepared should do well. The others, well, someone has to pay the winners.
Dr. Richard Heller, vice president, clinical services and national director of pediatric radiology at Radiology Partners and Basak Ertan, chief revenue officer at Radiology Partners.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
