The drive toward value-based care is requiring the healthcare industry to make a 180-degree turn from where we were just a few years ago. We’re moving away from a system focused on treating sickness to one that strives for wellness; from encouraging volume to demanding value; from filling beds to penalizing readmissions; and finally, from a system centered on the provider to one that rightfully revolves around the patient.
Announcement provides proprietary information to accelerate healthcare transformation
Washington, DC -- Independent accreditor URAC today made public its proprietary standards for the organization’s Patient Centered Medical Home (PCMH) program. The announcement, which provides a complimentary download of the PCMH Certification standards, is part of an effort to help primary care practices nationwide implement best practices for providing value-based, quality medical services.
By James (Larry) Holly, M.D., CEO, Southeast Texas Medical Associates
Southeast Texas Medical Associates’ (SETMA’s) pilgrimage toward Patient-Centered Medical Home (PCMH) began in 1999 as a result of our study of Peter Senge’s The Fifth Discipline. In that study, we identified ten principles which would guide our development in both our practice and in the electronic medical record (EMR) tool which we would design. (see SETMA: May, 1999 - Four Seminal Events) Ten years into our development, we realized that those ten principles were also the principles of PCMH.
With the final MACRA rule released on Oct. 14, the industry is now getting the chance to dig into all of the details of this 2,300-page document, especially the act’s Quality Payment Program, which replaces the Sustainable Growth Rate formula with two tracks of reimbursement—the Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS).
“Folks are now in the process of getting their heads around what’s in the final rule and determining what they have to do to respond in 2017,” said Aaron Turner-Phifer, URAC’s director of government relations and policy. “The most important thing right now is for practices and clinicians to be engaging with their medical societies and educating themselves on the best path forward.”
Watch this video for quick overview about MACRA (Medicare Access and CHIP Reauthorization Act of 2015), and what you need to do to succeed in the new healthcare economy.
A foundational principle of all healthcare providers is to keep the focus on patients and their specific needs. It’s also the philosophy at the heart of the Patient-Centered Medical Home concept.This concept and process can serve as invaluable guidance for transforming your practice, especially in the shift toward value-based reimbursement
Commenting on the imminent release of a final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt anticipated this new healthcare policy will give providers a “proliferation of opportunities.”
The final MACRA rule is expected to be released by CMS on or about November 1. It will implement the Quality Payment Program (QPP) that will replace the Sustainable Growth Rate governing Medicare reimbursements for providers treating Medicare beneficiaries. The QPP promotes value-based, coordinated care over the traditional fee-for-service method. It requires that participating practices cite progress through measures of performance.
While most healthcare providers agree the move toward fee-for-value is a positive advance for the healthcare industry, this shift away from fee-for-service isn’t coming without its challenges.
That’s especially true for providers who serve patients in rural and underserved areas and now must implement changes dictated by the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA.