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'Slow and steady' philosophy should rule volume to value transition, HFMA ANI expert says

Never be too far ahead or too far behind when it comes to participation in value-based payment models, expert says.

Jeff Lagasse, Associate Editor

When it comes to physician compensation under MACRA, slow and steady will win the race. Speaking at the Healthcare Financial Management Association's annual ANI conference in Orlando, Florida on June 25, the Coker Group's Senior Vice President of Healthcare Consulting Justin Chamblee said it's important to not be too far ahead, or behind when it comes to participation in value-based payment models.

"You never want to say, 'Hey, nothing's changing and we're not going to do anything,'" said Chamblee. "Some of our clients say that. They have lucrative payer contracts and say, 'We'll tough it out until something actually does change.' We have others who want to be very progressive because there are external drivers to enhancing performance but there are also internal drivers."

Physicians, he said, are generally going to do what they're incentivized to do. If the incentive is to improve quality, that requires a robust quality management system because if MACRA has proven anything, it's that it casts a wide net. Chamblee called it "the biggest universal change we've seen thus far" that affects all players in the realm of value-based care.

[Also: MACRA shows CMS is all-in on value]

And the overarching goals of the Centers for Medicare and Medicaid Services are pretty bold, he said. Over the next few years, Medicare wants 90 percent of reimbursement tied to quality, or value. If there's a discrepancy between a physician's reimbursement model and the compensation model, that could well be problematic.

"In some respects, it's all about technology," said Chamblee. "It's all about data."

Coding becomes important in how well a physician is documenting their patient population. If the documentation is poor, it can make patients look healthier than they actually are, and the physician in question stands to be penalized more as a result. When they're being evaluated from a cost perspective, everything has to make sense.

[Also: Payer Reporting Key to Value-Based Care Success]

William Strimel, president of the Mercy Physician Network, said many physicians are being pushed to consolidate to survive in the MACRA era. But that isn't necessarily a bad thing. The way to deal with controlling costs in the future is through the different emerging forms of reimbursement, and what has happened with cardiologists provides a case study as to why: Some cardiologists were so heavily dependent on revenues and profits from ancillaries that they struggled to make ends meet, so they were driven to alignment to survive. And survive they did.

"It's a culture of shared success," said Strimel. "Physicians don't have to be afraid of consolidation."

[Also: AHIP: No matter the political landscape, value-based care will continue]

Max Reiboldt, the Coker Group's president and CEO, said that while the Senate's version of a GOP bid to replace the Affordable Care Act has caused uncertainty in the broader healthcare industry, the transition from volume-based to value-based reimbursement models will likely continue.

"A lot of these concepts are not going to change," said Reiboldt. "Nobody's talking about getting rid of MACRA."

Twitter: @JELagasse

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