CMO Notes
CEO Notes
Special Note - Zika Virus
Executive Notes
About People
Marketing Update
Keeping Up
Kudos and Awards

Archive
Return to Main
Questions or Comments

Executive Notes


PHO Update



Rowena Bergmans
VP Clinical Integration and Population Health

The Population Management Train has left the station.

Say Goodbye to Fee for Service


First, some terms:

CMS Centers for Medicare and Medicaid Services
APM Alternative Payment Models
PCMH Patient Centered Medical Home
ACO Accountable Care Organization
MIPS Merit-Based Incentive Payment System
PQRS Physician Quality Reporting System
MU Meaningful Use
VBM Value Based Modifiers

All the meetings and memos about the transition to value based contracted care can be boiled down to these three things:

  1. Medicare and Medicaid have openly expressed their dislike for the current fee for service (FFS) payment system.

    Consequently, by 2018 50% of all CMS payments will be tied to quality and/or alternative payment models (APMs). CMS currently recognizes Patient Centered Medical Homes (PCMH), Bundled Payments and Accountable Care Organizations (ACOs) as APMs. If you choose not to participate in APM then you will be required to participate in the Merit-Based Incentive Payment System (MIPS) which will begin in 2019.

  2. Your income will be affected by your effectiveness and participation in APMs or MIPS. CMS has established only these two payment tracks beginning 2019: MIPS and APMs.

    MIPS replaces several CMS programs: PQRS, MU and VBM. These independent programs will be replaced with an aggregate score. Based on this score you could either see an increase or decrease in your reimbursement.

    These adjustments begin in 2019 with a 4% adjustment, 5% in 2020, 7% in 2021 and 9% by 2022. Physicians participating in APMs are exempt from the MIPS. If you choose to participate in the APM program then you do have an opportunity to receive a 5% bonus but you must also accept downside risk.

  3. Help is available. These changes are complicated and important. The PHO provides contracting expertise, practice management support as well as resources and programs that can help your organization become risk ready to adapt to the rapidly evolving delivery models. Your success in the future will depend on care management effectiveness, population health competencies and business analytics.

Providing the best care for your patients during this transition will be a challenge. The PHO wants to provide you with all the information you need to make the best choices for your patients, your practice and yourself.

For more information:

Click here to download the WCHN PHO/ACO Annual Meeting powerpoint by Rowena Bergmans
Click here to view the PHO Annual Meeting PDF by Robert Carr, M.D.

Or contact:

Rowena.bergmans@wchn.org
Robert.carr@wchn.org


BACK TO EXECUTIVE NOTES

Click here to return to the top of the page