With barely two months of 2017 behind us, the transition health care providers are experiencing is significant. Between the uncertainty surrounding the Affordable Care Act and the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), providers are justifiably concerned about future reimbursements for the care they provide.
With the potential of as much as a 4 to 9 percent bonus (or penalty) for Medicare reimbursements based on performance in the next five years, the financial stakes are huge. One clear path forward for clinicians who are grappling with the intricacies and uncertainties of MACRA or the Quality Payment Program (QPP) can be participation in the Transforming Clinical Practice Initiative (TCPI).
“A TCPI network offers tremendous support for clinicians in transforming their practice for success with MACRA,” said Robert Dean, DO, MBA, senior vice president, performance management at Vizient. “The TCPI networks offer clinicians the tools, training and support necessary to improve in each performance area within the MACRA scorecard for both avenues of the QPP; those avenues being either the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APM).
The TCPI is a service delivery innovation model launched by CMS in 2015. The goal is to recruit 140,000 clinicians nationwide to lead the movement of physician practices into a value-based care and reimbursement environment. Vizient was selected to participate in TCPI in 2015 as one of 29 Practice Transformation Networks (PTNs) in the country. To assist clinicians in their practice transformation, the Vizient PTN provides technical assistance, advanced data analytics and collaborative education opportunities.
As with any transformation, there is a significant culture change component and the process is slow but steady. “It is like a sunrise or sunset, not a light switch,” Dean said. “It doesn’t just happen, it takes time.”
Payments based on performance
With the passage of MACRA, clinicians in practices serving more than 100 Medicare-eligible patients a year must select either the MIPS or APMs for compensation in 2017. The two avenues align with CMS’ overall move to value-based reimbursement.
The MIPS option offers a new modified fee-for-service schedule that uses a four-component composite scorecard measuring clinicians based on:
- The use of electronic health technology
- Practice improvement areas, such as:
- Care coordination
- Patient engagement
- Improved access
- Cost of care or resource use
How well a clinician performs the delivery of care in these four areas impacts what they receive from the fee-for-service schedule.
The other method of value-based reimbursement is participation in an APM. In this dynamic, physicians and clinicians participate in either a Medicare shared savings plan, an accountable care organization or bundled payments; each are options to be reimbursed in the value-based methodology under MACRA.
“In either of the two different ways you can be paid under MACRA, both are tied to improved outcomes, improved quality and improved patient engagement,” Dean said.
Keeping score of performance-based care
Whether providers select MIPS or the APM, there are three focus areas within the TCPI Change Package (the clinician-developed concepts which transform the day-to-day operations of a typical practice) that will drive improvements necessary for success in MACRA: patient and family-centered care design, continuous data-driven quality improvement and sustainable business operations.
Equally important, participation in TCPI means clinicians don’t have to manage the transition to value-based care and MACRA compliance alone. Vizient employs TCPI advisors that facilitate the education, transformation and culture change necessary to move forward successfully.
“What Vizient helps with is getting physicians and clinicians to look at performance data and their practice in a perspective which they traditionally have not done,” Dean said. “We’re getting them to recognize the need to change the way they deliver care in order to improve the quality of the data they’re seeing, improve measurements, improve performance and ultimately, improve patient outcomes.”
For more information on how TCPI helps your organization and its integrated physicians move closer to delivering value-based care, and participating in the program, please click here.