Increasing Impetus on Physician Reimbursements Becoming Value-Based

Both federal and private payers are shifting compensation from volume to value of services. According to American Medical News one of such payers is UnitedHealth Group who is to start offering approximately 50- 70% of its physician’s bonuses for reaching cost and quality targets and/or participating in new care models.

Increased numbers of physician practices are likely to experience this shift soon with other large health plans, like Aetna and WellPoint, already using the value-based incentives model. In addition Medicare’s shared savings program is also offering “shared savings” to the pioneers of Accountable Care Organization (ACO) who are improving quality of care and reducing costs. Overall the shift to value is not a passing trend states American Medical News especially with UnitedHealth Group US’s largest health plan, with physicians in every state, also adopting this trend.

Shift putting physicians at risk for lower reimbursements?

As of now as a majority of insurers shift reimbursements towards value, are not yet putting their physicians at risk for lower reimbursements. Nevertheless this is likely to change soon- with physicians who do not meet quality outcome requirements and lower readmissions will in most probability begin experiencing reimbursement reductions.

Medicare and other payers are expected to continue taking steps to encourage increased number of medical groups to concentrate on the outcome rather than volume consequently in this scenario practices need to start gearing up and adjusting themselves accordingly for a shift from volume to value to assure smooth revenue generation.

Physicians get geared

Contrary to what some entities may feel physicians can do well in areas of both quality and productivity at the same time, but for that physicians will need to apply best practices for streamlining care, learn from other successful practices and understand resources needed to track quality and cost indicators. Outlined below are some measures Physicians may find necessary to take to help in value based reimbursements:

  • Proof: physicians may need to establish that they are providing quality care at reduced cost
  • Documents: fully utilize EHR to document patient information and be able to quickly share patient information with other providers due to increased care coordination
  • Data Analysis: analyze data generated through EHR to help determine performance
  • Patient engagement:  soon to become an increasing factor related to payments

Though the shift from volume to value is stressful, it has potential for physicians as if it is successful they may see higher reimbursements, for which they need to spend  good quality time with patients, but may be pressed for time to address the other measures mentioned earlier. As physicians move towards a value based system of healthcare delivery, they would be well-off having an advisory from experienced Medical Billing Companies which can offer a balanced approach for both operational as well as revenue maximization. besides managing your practice’s medical billing our medical billers and coders can guide the practice right from the EHR best suited for your practice to data analysis and assist in incentive maximization contributing towards the healthcare goal of providing quality and cost‐effective healthcare services.