History will doubtless record the collapse of healthcare\u2019s traditional fee-for-service model. While the ransacking of fee-for-service has taken longer than Visigoth King Alaric\u2019s three-day siege and sack of Rome in 410 AD, both the medical community and the Romans should have seen it coming. After all, when Alaric breached the city gate it was his third siege in as many years. As for the healthcare industry, it began marching inexorably toward value-based reimbursement (VBR) with the advent of Medicare\u2019s Professional Standards Review Organizations in 1972.<\/p>\n
<\/p>\n
This reimbursement evolution has caught most healthcare organizations unprepared \u2013 even as history writes the fee-for-service obituary. <\/span>Medical groups paying attention understand that actionable data (both quality and financial), which can only be gathered from an EHR <\/span>set up to collect that data<\/i><\/b>,<\/span> will have a HUGE impact on an organization\u2019s ability to weather the vanguard. Actually, there are only a handful of health tech companies that sent out early scouting parties and that have already retooled their EHR to be a partner and not a hindrance.<\/span><\/p>\n The truth is, ICD-10, Meaningful Use, EHR incentive programs, and PQRS have all acted as expeditionary forces for alternate payment models (APMs). But unlike ICD-10\u2019s myriad stops, starts, and delays, APMs are storming the gates. CMS is actually ahead of its stated 30% fee-for-service replacement goal for the end of 2016. They\u2019re highly motivated to get this done in short order because if they know one thing, it\u2019s this \u2013 they will save even more money than forecast because most healthcare providers will ignore the warning flares and delay adopting the right technology and tools until the change is forced upon them. And by then, it\u2019s too late. Too late to make the necessary modifications to care delivery. Too late to collect the required history of data. Too late to change treatment protocols to a \u201cless is more\u201d focus. Too late to call in the cavalry.<\/span><\/p>\n Some may think, \u201cNo big deal\u2026. I\u2019ll just read the new regs and figure it out.\u201d Have they actually read the CMS guidelines for all the new acronym models? We\u2019re talking about MACRA, MIPS, and other APMs streaming into the system. Trying to understand EXACTLY how to prepare gets lost in the fog of trying to understand EXACTLY what in the heck these models are.<\/span><\/p>\n After five years on the march (and on the road) rallying forces behind the idea that ICD-10 is critical to the future of medical groups, we\u2019ve come full circle. When I spoke about ICD-10 as a harbinger for ACOs and value-based reimbursement, folks looked at me as though I had two heads. Now even a quick glance at Twitter or LinkedIn reveals a plethora of articles about VBR models.<\/span><\/p>\n The coming series of articles will deliver valuable information concisely and \u2013 fingers crossed \u2013 engagingly. We\u2019ll start with background information about MARCA and MIPS, and then move into defining the different types of APMs. You\u2019ll learn about the payer movement towards APMs and what medical groups are doing right now. Most importantly, we\u2019ll discuss which industries are ready to deliver good data that will position you to receive high reimbursements. Finally, you\u2019ll receive solid advice about how to prepare your group to succeed within these new payment models.<\/span><\/p>\n In the meantime, consider the words of Henry Wadsworth Longfellow, who wrote, \u201cAll things must change; to something new, to something strange.\u201d Change is the one true constant in the healthcare industry. Benefitting from that change requires clear-eyed awareness of the challenges that lay ahead \u2013 and turning the tables on the Visigoths at the gate.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":" History will doubtless record the collapse of healthcare\u2019s traditional fee-for-service model. While the ransacking of fee-for-service has taken longer than Visigoth King Alaric\u2019s three-day siege and sack of Rome in 410 AD, both the medical community and the Romans should have seen it coming. After all, when Alaric breached the city gate it was his […]<\/p>\n","protected":false},"author":1,"featured_media":43303,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[37,69],"tags":[68,11,12,118,172,146,38,75,312,63,119,313,91,314,315],"class_list":["post-16714","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-regulations","category-show","tag-5-must-track-metrics","tag-analytics","tag-big-data","tag-certified-ehr","tag-cms","tag-electronic-health-records","tag-icd-10","tag-icd-10-codes","tag-macra","tag-meaningful-use","tag-medicare","tag-mips","tag-practice-management-2","tag-value-based-reimbursement","tag-vbr"],"yoast_head":"\n