MDNews - Greater Kansas

PHOTO © two large-scale trials — the Physician Quality Reporting program and the Pioneer ACO Model program — both of which have demonstrated early successes. According to Richard Hodach, M.D., Chief Medical Offi cer at Phytel, which provides health care IT solutions, enrolling in one of these programs is a good starting point for physician groups trying to maintain leverage in the changing reimbursement landscape. "Another option is to become a Patient-Centered Medical Home [PCMH]," Dr. Hodach says. "This model actually delivers the imbursement needed to invest in infrastructure changes and still manage patient care. PCMHs are catching on, and payors are beginning to notice." The Patient-Centered Approach In the PCMH model, physicians are paid for services associated with coordination of care both within their practice and between consultants, ancillary providers and community resources. They also share in savings generated by reduced hospitalizations as a direct result of better patient management. Many PCMH practices have developed a chief medical informatics offi cer (CMIO) role or similar position to help implement the health care information technologies necessary to coordinate care between the primary care physicians and secondary providers. According to a 2011 study by the Medical Group Management Association, nearly 70% of respondents were in the process of transforming into, or interested in becoming, PCMHs, while more than 20% of those respondents were already accredited or recognized as PCMHs. Dr. Hodach notes that approximately 80% of Phytel's clients are currently pursuing the PCMH route. Though still early in the game, it appears that changes in the reimbursement structure are inspiring changes in the way physicians are approach- ing patient care, pushing them to abandon volume- based care in REIMBURSEMENT IN 2012 CONGRESS PASSED LEGISLATION at the last minute in late 2011 to temporarily avert the 27.4% cut in Medicare physician reimbursement. However, other features of the revised Medicare physician fee schedule went into effect January 1. Here are a few highlights: + The Centers for Medicare and Medicaid Services (CMS) will undertake a misvalued code initiative to examine the highest expenditure codes across all specialties and determine over- or undervalued codes. + CMS will utilize a new value-based payment modifi er based on quality and effi ciency to determine physician reimbursement adjustments. + Relative value units for subsequent observation services will mirror those of subsequent hospital inpatient services. + A health risk assessment will be required as part of a Medicare annual wellness visit, for which CMS will pay a higher reimbursement rate. favor of outcome-based standards for a given health population. "Because of the dramatic ineffi ciencies in the current health care system, physician groups that embrace efficiency can substantially reduce costs and put those savings back in their own wallets," says Charles Kennedy, M.D., Chief Executive Offi cer of Accountable Care Solutions at Aetna. "Physicians who continue to practice the same way they always have — meaning fragmented, poorly coordinated care across multiple practices — will fi nd their fi nancial future increasingly challenging." ■ MDNEWS.COM ■ MD NEWS Greater Kansas | 11

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