Preparing Your Practice for Value-Based Care: Five Best Practices

April 1, 2021
April 1, 2021

We asked Lance Hebert, Vice President of Medical Group Credentialing and Provider Enrollment at Echo, A HealthStream Company, if there are things physicians should be doing to prepare for implementation of the Quality Payment Program. First, Hebert recommends that practices not delay. “With your Medicare reimbursement at risk based on your participation in the Quality Payment Program this year, it’s critical that you start now. Don’t leave money on the table by failing to prepare.” Hebert offered a few additional recommendations:

  • Understand the requirements. CMS and a host of others have offered numerous training materials to help educate physicians about the new requirements. Become familiar with the MIPS reporting requirements and the Advanced APM concept.
  • Choose your path, MIPS or APM. Decide if you will participate in MIPS or an Advanced APM. While most clinicians will initially participate in the Quality Payment Program under MIPS, confirm whether you are a participant in any of the risk-based models that are exempt from MIPS reporting and automatically eligible for a 5% payment incentive.
  • Decide how you will participate. As summarized above, CMS has outlined options for participation that allow clinicians to choose the pace at which they will participate in the first year of the program. Review the options and decide which you will pursue.
  • Dedicate resources and explore platform solutions. Surround yourself with talented resources for technology, clinical quality, and regulatory compliance. Whether your own staff or contracted experts, you need dedicated resources tasked with ensuring compliance with the new reporting requirements. Platform solutions can help you capture, analyze, and submit the new reporting requirements. Further, prioritize training initiatives that can help optimize your results. Best bet—find a partner who can help with both!
  • Have a plan and mitigate risk. Create a detailed roadmap for your team to follow and an action plan for each reporting requirement. It is also important to understand the potential pitfalls and to have a concrete plan in place to mitigate those risks. The transition to reporting under the Quality Payment Program is not a once-and-done project. It will require a long-term vision and flexibility along the way.

The Quality Payment Program will require physicians, hospitals, healthcare organizations, and medical groups to support the heavy burden of data collection and the associated cost necessary to survive in the world of Quality Payment Program reporting. Additionally, this new payment system will most certainly accelerate the shift in hospital-physician relationships. Some physicians, especially solo practitioners and those in smaller groups, may find the stability of hospital employment more appealing. And given the significant incentives to participate in Advanced APMs, there will likely be more pressure to participate in risk-bearing relationships.

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