Value-based care (VBC) impacts how providers and practices are paid for services. The model, spearheaded by the Centers for Medicaid and Medicare Services (CMS), seeks to shift payment away from fee-for-service reimbursement and focus on priorities like patient outcomes and quality of care, cost efficiencies, and interoperability.
Benefits of Value-Based Care
Value-based care aims to enhance the quality of patient care by tracking measurable improvements across the sector. At the practice level, it pushes you and your staff to become data-driven as you follow performance for reporting purposes.
Your reporting, in turn, impacts your income. For instance, MIPS is designed to reward providers who provide high-quality care and penalize those who do not meet the performance criteria. To comprehend what’s at stake in 2022, you could receive up to a maximum payment adjustment of 9% in 2024 for the performance year 2022. For $1 million billed in Medicare, that could be up to a $90,000 bonus or penalty.
Complying with Value-Based Care Models
Since value-based care can significantly impact your practice, you must equip yourself with technology that streamlines your ability to comply with VBC programs.
According to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), CMS determines payment amounts as part of its Quality Payment Program (QPP). Providers have two tracks to choose from under QPP, depending on practice details, like specialty, location, size, or patient population. One is called the Advanced Alternative Payment Model, and the other is the Merit-based Incentive Payment System (MIPS).
Role of EHR in Submitting Your MIPS Reporting Data
- Collect MIPS data during the exam without lots of extra time or clicks
- Track your estimated MIPS Composite Score
- Monitor progress on each measure and category
- Benchmark your performance against peers daily
- Submit data to CMS through specialized registries
Registries and EHR
Tracking quality measures and accessing registries can be complex and time-consuming. Registry solutions can help you experience relief from the weight of reporting responsibilities by eliminating the need for manual reporting.
Clinical data registries, previously known as specialized registries, are integrated with our EHR System, so it can easily report to them.
Impact of Value-Based Care
The impact of value-based care can be sweeping for your practice. Ultimately, since your outcomes determine your income, you must have the tools and frameworks to track performance, surface actionable insights, make indicated changes, and submit accurate reports communicating your practice’s value.
Easy access to the correct data can help improve the quality of patient care while reducing operational and administrative burdens on your staff. At scale, this data can contribute meaningfully to the benefits of value-based care and create a fuller picture of how the medical industry can continue to improve its offerings to society.
More immediately, your data impact your payment from CMS. Under MIPS, your payments are adjusted based on CMS evaluation of your performance across different categories: quality, interoperability, improvement activities, and cost activities.
For practices with more than 15 clinicians, the following represents how to measure the impact of value-based care. Earned points and weighting varies if you’re identified as a small practice.
Winding Up
The value-based care model continues to urge the medical industry towards a more data-driven approach, it can become easier to realize its intended benefits. VBC may help prevent illness or injury from becoming more severe or chronic for patients. As payers gain control of costs, care may become more accessible for many. Improving the quality of care may become more reliable for physicians as data underpins decisions. That data also directly impacts practices’ financial health, redirecting incentives toward the measurable quality of care.