Ten tips on maximizing value-based payment

Naveed Saleh, MD, MS | February 07, 2022

Physicians who depend on reimbursement from CMS tangle with value based payment (VBP) systems, a regulatory framework intended to hold providers accountable for healthcare quality and cost. CMS promotes these systems as providing better care for individual patients, better health for populations, and lower costs compared with the traditional fee-for-service (FFS) model. 

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A physician listens to a patient's heart using a stethoscope.

In many ways, the passage of the Affordable Care Act kicked off and codified the transition to VBP, and for many providers, that transition has been challenging. This trend, however, is here to stay. With some tactical adjustments, clinicians can work within this emerging system to improve care and maximize remuneration.

Shortcomings with VBP

According to a Deloitte analysis, physician compensation continues to be tied to volume vs value. Substantial performance bonuses are uncommon, and most compensation is still derived from traditional sources, such as salary and FFS.

In other findings, 97% of physicians depended on fee for service (FFS) for salary, with 36% also receiving some value-based payments. Furthermore, the number of physicians who received performance bonuses of greater than 5% held steady at 23%. 

Other concerns include:

  • Half of physicians understand the costs of the treatments they choose.

  • Fewer than half adhere to clinical pathways promoted by their healthcare organizations.

  • Existing infrastructure does not support value-based care, with opportunities for efficiency and quality of care lost.

  • Data-driven tools that help physicians deliver value-based care are lacking.

How to maximize VBP

Even though VBP may be imperfect, it’s likely here to stay. Making the most out of value-based pay is multifaceted. The AAFP provides some useful insights, calling the needs for greater efficiency and effectiveness urgent.

“‘Efficiency’ is understood to mean ‘doing the thing right’ and ‘effectiveness’ means ‘doing the right thing.’ VBP is one approach to achieving a balance between efficiency and effectiveness,” they wrote.

Here are 10 tips to consider based on AAFP guidance.

  1. Remain flexible to community needs and resources. Remain dynamic when adapting to different organization models and structures.

  2. Focus on attainable improvements in clinical outcomes.

  3. Respond to the preferences of patients from different socio-cultural backgrounds. Also respond to needs, preferences, and resources of the community. Always consider healthcare disparities.

  4. Align payment models with performance measures across payers, purchasers, and patients.

  5. Focus on reducing per-capita healthcare costs.

  6. Leverage performance measures that are evidence based and suggested by the National Quality Forum. Make sure that these measures are clinically relevant and consistent across stakeholders.

  7. Make multidimensional assessments of quality and cost.

  8. Make decisions based on data that is timely, accurate, and transparent.

  9. Assess provider capacity and tolerability for performance risk.

  10. Understand the tradeoffs of value decisions.

An article in Becker’s Hospital Review examines how practices can make the most of VPB.

  1. Identify the components of the practice that are VBP and FFS and strategize accordingly.

  2. Make long-term goals that plan around infrastructure needs to maximize VBP. Additionally, plan how to use resources derived from VBP performance success.

  3. Transform infrastructure to maximize gains from VBP. This step could mean taking a team-based approach to care that decreases expenses. 

  4. Keep tabs on metrics with regular reporting.

Sources

  1. Equipping Physicians for Value-Based Care. Deloitte.

  2. Value-Based Payment. AAFP.

  3. 5 steps to improve margin via value-based payment. Becker’s Hospital Review.

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