It seems like forever now that practices have been dealing with multiple, complex, incentive and penalty initiatives from the federal government: Meaningful Use, PQRI/PQRS, eRx, PCMH and, more recently, “value-based” programs (value-based purchasing for hospitals, and the upcoming value-based purchasing modifier for physicians).

If you’re like us, the onslaught of these programs has seemed more like a series of separate carrots and sticks (amplified by private payer programs that have built on the government’s pay-for-performance approach) than a coherent strategy for driving change.  Rarely do notices about these programs include helpful guidance as to how they’re interrelated.  (Perhaps it would just be to hard to fit those details in amongst the deadlines, bureaucratic details and confusing specs!)

That is why it is at least helpful to finally be seeing — after years of programs popping up and interrupting practice operations, demanding attention without saying why (except when why was ‘get a bonus’ or ‘avoid a penalty’) — the outlines of inter-connectedness among all of the government’s many programs.

For example, Medicare’s Physician Compare website provides information about a physician’s participation in various quality initiatives, like PQRS and ePrescribe.  (This is perhaps a good opportunity to remind you to check this — and all — the directories in which you or your providers are listed.  There are often errors — if contact, specialty or location data is incorrect on a key directory, it can cost you patients.  And if the CMS has incorrect data about your participation in important incentive programs, you’ll want to follow up on that immediately to remedy their data or your submissions.  As we say all the time, this need to check goes for payer directories (!) and public directories like Healthgrades and Vitals.)

Anyway, a sample of quality participation data as it is displayed on the Medicare site appears below.  For some patients, knowing you’re participating in these programs could make the difference in selecting your practice:

pqrs-physiciancompareex2Besides PQRS participation, the Physician Compare site shows participation in ePrescribe and Meaningful Use as well.

Of course, the integration of this data into directories is just the beginning.  The biggest change for payers and practices alike is the utilization of reported data in calculating value-based incentives and penalties. Beginning in 2015, practices will see their CMS revenues adjusted up or down by the value-based payment modifier (VBPM), which draws from Medicare claims, PQRS reporting data, and surveys of patients.  Even though practices won’t see their Medicare revenue increased or decreased via the VBPM until 2015, the CMS is providing practices with 25 or more providers an advance look at how the modifier is calculated via the Quality and Resource Use Reports (QRUR) report cards.

Other programs contribute to a more consolidated picture of CMS’s calculus of ‘quality’ and ‘value,’ such as the Meaningful Use initiatives (registry and EMR-vendor-based reporting may allow you to easily report PQRS data simultaneously).  And other programs like the PCMH and ACO initiatives both utilize and contribute to the data picture.

Even practices that are not concerned with Medicare will see these data initiatives impact their payer relationships and opportunities.  For example, of the 500ish ACOs currently functioning in the US, about 3/4 are private.  And private payers are implementing other initiatives that were inspired by government programs — like medical home and pay-for-performance/quality programs.  And the states are getting in on the act, too, with many introducing programs drawing inspiration from the Comprehensive Primary Care Initiative — and these programs can mean significant financial upside for practices.

More clarity should make it easier for practices to get their arms around these programs.  And, with at least one key deadline looming (PQRS for 2013), it’s time to get involved.

I’ll be leading a webinar overview of many aspects of payment model reform and change next Wednesday, Dec. 4.  It will be presented by Medical Economics magazine and sponsored by Kareo (@GoKareo).  It’s free — click here to register.

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