Central PA Medicine - February 2017 - 19

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SURVIVAL OF

PHYSICIANS IN A
VALUE-BASED WORLD
By DENNIS OLMSTEAD, MPA

e'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 healthcare, 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.

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
healthcare landscape, the Pennsylvania Medical
Society's 2016 House of Delegates (PAMED
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
Information from the Centers for Medicare a Management Services Organization (MSO)
and Medicaid Services (CMS), the Common- to help Pennsylvania physicians succeed in
wealth of Pennsylvania, and commercial payers value-based care, while maintaining leadership
indicates this value shift will account for a roles and clinical autonomy.
significant portion of physician reimbursement
within just a few short years.
The MSO will eventually provide services
within the general categories of insurance
As payment models quickly change, employers services, revenue cycle, practice operations, and
and payers are demanding greater accountability. finance and business operations. It will include
Physicians are in a unique position to work services such as front-end management as well
together to co-create meaningful solutions as back-end management of the practice, staff
that result in the highest quality of patient payroll, reimbursement, charge capture, appeals,
care available and the appropriate rewards for coding, practice management, etc., as well as
its delivery.
Medicare Access and CHIP Reauthorization Act
of 2015 (MACRA) readiness and Merit-Based
As a result, many physicians are joining Incentive Payment System (MIPS) reporting.
together to seek opportunities for higher levels These services will be available to any physician
of success amid these changes. By participating practicing in Pennsylvania or elsewhere.

As payment models
quickly change,
employers and payers
are demanding greater
accountability.
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 healthcare 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 healthcare for
the foreseeable future, and an established
physician-led, physician-owned network to
efficiently address the unknown health care
shifts of tomorrow.
Continued on page 20
Central PA Medicine February 2017 19

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