Medicare’s Value-Based Payments

A recent movement in the medical field, referred to as the “Medicare Access and CHIP Reauthorization Act” (MACRA) is now providing an annual bonus to medical professionals that are actively participating in alternative value-based payment models.

The total amount of the bonus is 5%. Additionally, this movement exempts these medical professionals from performing in the relatively new merit-based incentive system. The purpose and intent of Medicare’s value-based payment model is to assist doctors and other medical professionals in changing the way that they set up a care plan for their patients, to improve the quality of care that patients receive, and to control their spending.

If you are a medical professional, it is in your best interest – and, the best interests of your patients – to get onboard with Medicare’s value-based payment model.

The Goals
In order to truly understand the positive impact that Medicare’s value-based payment model will have on your practice, you should understand the goals associated with the model. They are as follows:

1. First, medical professionals will be provided with larger amounts of resources and a higher level of flexibility when it comes to delivering care to the patients that they serve.
2. Second, the financial-based viability of all specialty practices will be improved. This is especially true when it comes to practices that are considered to be independent.
3. The administrative-based burdens that are placed on medical professionals are dramatically reduced.
4. The payment model helps medical professionals to control various aspects of spending and takes away the control from insurance companies.
5. The payment model aids in transferring unnecessary financial-based risk from medical professionals so that the quality of care that patients receive is not detrimentally impacted.

The Process
Just as there are five goals associated with the value-based payment models offered by Medicare, there is a five-step process that helps make this payment model a viable option for medical professionals:

1. Medical professionals will be asked to pinpoint ways that patients may receive higher quality care at lower costs.
2. Barriers that are created by current payment models are identified.
3. Changes associated with payments are identified so that payment barriers may be eliminated.
4. Benefits for patients – such as quality care and low costs – are carefully evaluated.
5. A payment model is designed that removes all barriers so that patient outcomes are more positive and payers experience a vast array of savings.

In the past several years, most payment models were based on the volume of services rendered. It has been established that these models actually hurt payers and patients. In order to create a solid system that will benefit both medical professionals and patients, the payment model must be based on value-based care. If more payment models reflected that of Medicare’s most recent payment model, the system would – eventually – even out. This would mean more quality treatments for patients, more positive outcomes for patients, and fewer costs associated with the type of care provided by medical professionals.

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