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Shifting Attention: Value-Based Reimbursement Gains Traction

gaining_tractionBy Dave Gans, MSHA, FACMPE, Sr. Fellow, Industry Affairs, MGMA

While medical group practice executives juggle myriad tasks associated with compliance (Meaningful Use and ICD-10 to name two behemoths), an increasing number of practices are using quality metrics to influence provider compensation, according to the MGMA 2015 Physician Compensation & Production Report.

And this trend is expected to continue, says David N. Gans, FACMPE, senior fellow, MGMA Industry Affairs, who outlines some of the reasons for this shift toward value- versus volume-based reimbursement in an MGMA Connection Plus article.

“As payment shifts from fee-for-service to risk- or value-based payment, medical groups will need to change the way they reward physicians for consistently better outcomes and lower costs of care,” he explains. “This will especially be true for primary care physicians, who will have increased responsibilities for care management and coordinating referrals,” he adds.

The report, which was released in June, shows significant increases in the whole number percentage of provider total compensation based on quality metrics (excluding patient satisfaction). For example, compared with last year, MGMA data shows a 4.16% increase for primary care providers and a 2.70% increase for specialty care providers.

“Preparing for value-based payments” topped the list of challenges in the 2015 Medical Practice Today research for MGMA members, who are skeptical about their ability to meet requirements set by the government and private payers, and note the practical challenges of implementing quality programs.

Find out more about key challenges, strategies, and best practices for transitioning to a value-based world in the white paper, Successfully Transitioning to Value-Based Payment Models.