Revenue Cycle Management Blog | GroupOne Health Source

4 Ways Small Practices Can Best Prepare for Value-Based Care

Written by Jeff Jones, CPHP | January 3, 2017

When it comes to government regulations and health care, change is inevitable. In contrast to the current fee-for-service care, the value-based care model aims to compensate physicians for high-quality service, clinical performance, and patient satisfaction. It's an exciting time for the future of healthcare, and small practices are uniquely situated to thrive in the transition to value-based care.

One of the top concerns for physicians is the effect value-based care will have on revenue. According to Medical Economics, in the past three years, only 6 percent of total physician pay was tied to quality measures but is projected to jump to 20 percent under MACRA.

Of course, every practice wants to avoid any damage to their bottom line but, smaller practices in particular just can't afford it. 

When it comes to implementing supporting systems needed for population health and making the transition to value-based care, larger clinics may have a slight advantage considering they typically have a greater number of resources available. However, small practices have the opportunity to build upon the close relationships they share with their patients to improve health outcomes and reduce costs.

In fact, recent evidence suggests that small, physician-owned practices, while providing a greater level of personalization and responsiveness to patient needs, have lower average cost per patient.1

Small practice physicians can compete in a world of value-based care. Those that view value-based care as an opportunity to make improvements rather than a setback are most likely to succeed under this new model.

Educate Staff About The Quality Payment Program

By educating your staff today on the new value-based care program, you could reduce health care costs and improve clinical performance in the long run.

In June 2016, the Department of Health and Human Services (HHS) announced funding $20 million to train small practices on the Quality Payment Program. The program will be awarded for five years for a total of $100 million towards MACRA education. According to HHS:

"These funds will help provide hands-on training tailored to small practices, especially those in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas."

To take advantage of this opportunity, Medicare clinicians must apply with HHS each year.

Another resource for small practices to consider is the AMA STEPS Forward Program. The AMA offers a variety of online content that can be used as training material for your staff. You can also use their site to find a consultant to assist with the transition to value-based care.

When making the shift from service-based to value-based care, using credible educational materials that are free of cost will save you money and empower your staff to meet quality metrics.

[Also: 4 of the Best MACRA Resources for Your Practice]

Identify and Classify Your Patient Population with an EHR

Knowing your patient population is critical to providing quality health care and cutting costs under the value-based care model.

Using an Electronic Health Records (EHR) software to identify which patients have chronic diseases, high emergency room visits or risk of hospitalization gives providers the ability to make informed decisions that ultimately drive improved health outcomes while reducing costs.

Monitoring the frequency of clinic visits from patients with conditions such as high blood pressure, diabetes, or heart disease could help you identify necessary changes to improve patient outcomes and cut costs.

Use CPT Code 99490 for Chronic Care Management

CPT Code 99490 is beneficial to your practice and your patients. Medicare began paying for Chronic Care Management (CCM) in 2015 under code 99490, but many physicians didn't pursue the opportunity to bill for 99490 because of the number of requirements.

The good news? Some of these requirements have changed for 2017. Thanks to the MPFS Final Rule, the Chronic Care Management service elements, and billing requirements will be relaxed starting January 1, 2017. 

  • The requirement to provide the beneficiary with a written or electronic copy of the care plan prior to initiating CCM has been revised so that the care plan doesn't need to be in electronic or written format.
  • Obtaining a signed beneficiary consent form to receive CCM has also been revised. Obtaining written consent or documenting it in the medical records that the required information was explained and whether the beneficiary accepted or declined the services is now acceptable. Existing written agreements are not affected by this change.
  • The requirement that CCM may only be initiated during a Medicare annual wellness visit, initial preventive physical exam, or face-to-face evaluation and management visit applies only to patients who have not been seen within 12 months prior to commencement of CCM or new patients.
  • Access to the electronic care plan will no longer be required outside of normal business hours
  • Continuity of care documents can be shared via fax rather than requiring clinical summaries to be transmitted electronically.
  • Structured recording of patient information using a Certified EHR technology no longer includes the creation of a structured clinical summary record.
  • Beneficiaries no long need to provide authorization for electronic communication of his or her medical information with other treating providers. This authorization requirement has been removed.

These new and revised Medicare payment policies for Chronic Care Management offer new sources of revenue for small practices that are also trying to get a head start on the transition to value-based care. 

To learn more about the revisions taking place with CCM and to view all of the 2017 CPT code revisions, download our complete guide to the 2017 CPT Code changes here

Participate in Alternative Payment Models (APMs)

Physicians who participate in Advanced Alternative Payment Models (APMs) that are below MACRA thresholds are more likely to improve their Merit-Based Incentive Payment System (MIPS) scores.

Additionally, MACRA provides a 5 percent lump sum payment to physicians who participate in APMs. If losing revenue as a result of the value-based care model is a concern for you, APMs could serve as a safety net.

To learn more about APMs, the AMA offers a guide on 7 Physician-Focused Alternative Payment Models to help your small practice improve patient care and qualify for incentive programs under MACRA.  

Only members of AMA have access to download this resource, but you can also check out some of our previous posts on Alternative Payment Models:

Start Building a Nest Egg

The financial impact that the value-based care model will have on small practices is uncertain, but you can start making practical financial decisions today that will prepare you for the future. Start by cutting unnecessary costs to save money ahead of the impending changes and tighten up your revenue cycle management processes to increase your collections.

[Also: Healthcare Metrics You Need to Track In an Age of Value-Based Payment]

The best decision you can make for your small practice is to start preparing for the value-based model today instead of waiting to sort matters out when regulations have been implemented.

1Robinson JCMiller KM. Total expenditures per patient in hospital-owned and physician-owned physician organizations in California. JAMA.2014;312(16):16631669.