Survival of Physicians in a Value-Based World

We’re past the tipping point as we proceed headlong into new market-driven accountability for quality, cost, and value. As employers and payers demand proven, value-based health care, and the market shifts from rewarding volume to rewarding value, physicians must be able to demonstrate the highest standard of care to effectively remain competitive for the foreseeable future. It’s not something we should do — it’s something we must do.


Information from the Centers for Medicare and Medicaid Services (CMS), the Commonwealth of Pennsylvania, and commercial payers indicates this value shift will account for a significant portion of physician reimbursement within just a few short years.


As payment models quickly change, employers and payers are demanding greater accountability. Physicians are in a unique position to work together to co-create meaningful solutions that result in the highest quality of patient care available and the appropriate rewards for its delivery.

As a result, many physicians are joining together to seek opportunities for higher levels of success amid these changes. By participating in an aggregated, larger network while maintaining practice autonomy, physicians are given every opportunity to succeed in the new value-based world.


To lead this effort and help Pennsylvania physicians survive and thrive in this new health care landscape, the Pennsylvania Medical Society’s 2016 House of Delegates (HOD) passed a landmark initiative on Oct. 23, 2016. This historic initiative — called the Practice Options Initiative ― will create clinically integrated networks (CINs) as well as a Management Services Organization (MSO) to help Pennsylvania physicians succeed in value-based care, while maintaining leadership roles and clinical autonomy.


The MSO will initially provide services within the general categories of revenue cycle, practice operations, and finance and business operations. It will include services such as front end management as well as back end management of the practice, staff payroll, reimbursement, charge capture, appeals, coding , practice management, etc., as well as Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) readiness and Merit-Based Incentive Payment System (MIPS) reporting. These services will be available to any physician practicing in Pennsylvania or elsewhere.


One way physicians can succeed in value-based care is through CINs. A CIN is a group of separate practices – each with a unique Tax Identification Number (TIN) – collaborating to demonstrate value, meet quality metrics, and improve patient outcomes. This is a direct response to the evolving health care delivery system, which is moving rapidly toward value-based care led by passage of MACRA and its accompanying regulations. This guidance outlines the use of MIPS reporting and development of Alternative Payment Models (APMs).


A well-led CIN provides the infrastructure to efficiently, effectively, and comprehensively address the known issues in health care for the foreseeable future, and an established physician-led, physician- owned network to efficiently address the unknown health care shifts of tomorrow.


In a physician-owned and physician-led CIN, physicians are not only “at the table,” but are creating and implementing the local approach collectively. The more physicians understand the value of physician-driven networks, the more successful and sustainable they will be as health care leaders. It will also increase professional satisfaction — a very important part of who physicians are, and something that has recently been at an all-time low.


The ultimate goal is for CINs to serve as the high-performing, local catalysts for greater value for the health care dollar, while rewarding participating physicians for their work. PAMED plans to advance these networks by providing physicians with the knowledge, tools, and confidence that patients are receiving the best, most appropriate care possible throughout the entire continuum of care provided.


This means physician engagement must occur at a granular level. Physician-created initiatives, with input and buy-in from the entire network, and resulting in better overall coordination, is a cornerstone of success. This will allow physicians to directly affect health outcomes for large populations of patients while also being able to bend the cost curve, as the market so desperately needs.


PAMED must and will support physicians during this transition through use of services offered through the MSO or CINs. PAMED is looking to engage Pennsylvania physicians; provide the necessary education, clinical tools, and data; and offer hands-on practice support to assure successful transitions. This is the value of becoming part a CIN, and of being a PAMED member.


If you would like additional information about PAMED’s Practice Options Initiative, please contact Dennis Olmstead, PAMED’s senior advisor of health policy and economics, through PAMED’s Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.


If you haven’t already, check out PAMED’s online, on-demand CME series — “Addressing Physician Uncertainty about Payment Reform: Skills for Success in Value-Based Delivery Systems.” Free to PAMED members, this series is facilitated by Ray Fabius, MD, a PAMED member and a nationally respected expert in the field of population health. It covers a variety of important topics, including practical health informatics, using a data toolbox in your practice, quality management, process improvement, lessons learned from the managed care era, and population health. Access the CME at www.pamedsoc.org/valuebasedcare.


A version of this article first appeared in the summer 2016 issue of Pennsylvania Physician and was updated on Dec. 13, 2016.

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Allegheny County Medical Society
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