Should Cardiologists Worry Over Value-based Payment?

With the Affordable Care Act come a slew of changes in the healthcare sector. Moreover the transition from ICD-9 to ICD-10 brings its own change that is leading to a whole lot of changes inside the medical portals. One of such reforms is the Value-based Payment system (VBP): paying physicians based on quality and efficiency rather than for the volume of services provided by them. It has been designed with the aim of making the American citizen healthier and the system more accountable and less costly.

The practitioners most affected will be the cardiologists, as they attend to the more critical of patients and also the more elderly, and specifically as their patients are the ones who rely on Medicare. There is a gradual movement from the traditional Fee-For-Service approach model towards an approach wherein the system can bundle care across time and provider type. For instance, it has been cited that the health official’s goal is to tie 85% of all Medicare fee-for-service payments to quality or value by 2016 and 90% by 2018.

According to a few physicians, this fundamental shift from FFS to payment for value is going to put more risk on providers, especially as the government becomes a larger “payer” in the healthcare system, as Cardiovascular (CV) care itself comprises nearly 40% of Medicare dollars expensed. Moreover, VBP system presents an opportunity for cardiologists in particular, to work with hospitals to increase their own compensation.

With this new approach underway, with time, patients and physicians will see better integration of care providers, hospitals and physicians thus leading to better decision-making by patients  paying through deductibles and copays under the new healthcare reform measures. A significant for cardiologists in particular is that CMS has at first increased costs to patients and then directs patients to a provider who can deliver their CV care, rather than patients determining who their provider will be. This impact will be felt on cardiologists as nearly 60% to 65% of their current patient population comprises Medicare patients!

Against the above scenario, with the transition changes in ICD-10 coming in and a dip in revenues expected in the initial phases, cardiologists can use the VBP components that are compensated via Medicare to increase their revenues. For this, the codes employed for ICD-10 for cardiology, will need to be exact and filled in accurately, so as to help increase and make smooth the cardiology billing services, especially with submissions to Medicare being a major chunk of the payments. As the ACA will be bringing in many more Americans under its umbrella- earlier uninsured under its fold, the category of those suffering from CV problems will certainly increase the footfalls for cardiologists.

This value based payments system, meant to enhance quality of life for the American citizens will thus also enhance and boost the revenue for cardiologists – a win-win situation for all concerned.