Your Guide to Medicare Value-Based Care

April 2015 

Amy Lynn Sorrel - Texas Medicine Magazine

The alphabet soup of Medicare's quality reporting programs has not been easy for physicians to swallow, or follow. But for many, they are an entry point to a fast approaching value-based care system that seeks to break the cycle of high health care spending and reorganize and reward care delivery around better patient health. 

This guide breaks down the what, when, why, and how behind what has become a confusing web of requirements for physician practices at a critical juncture: In 2015, all three of Medicare's main physician quality reporting programs start penalizing practices for noncompliance, and penalties will grow into the future. 

Medicare's approach certainly has its flaws, and medicine continues to advocate for fixes that streamline the myriad administrative requirements and appropriately measure and value physician performance. At the same time, the programs were intended to give physicians clinical data to help them improve health outcomes, and Medicare finally released quality and cost reports that Texas Medical Association officials say physicians should use to gauge how these value-based programs likely will impact their practices.

"As with any government program, they made it harder than it should be. But they are in the right arena in terms of trying to drive toward quality," says TMA Council on Health Care Quality member Michael Ragain, MD. The family physician is chief medical officer at University Medical Center (UMC) Health System in Lubbock. 

Physicians will have to do their own math to determine the cost of the programs versus the penalty of foregoing participation, he says. "Many physicians may not have the option not to participate based on their patient population, now that so many patients are covered by Medicare. So they definitely should pay attention. It will hurt financially — and by reputation — if they get a bad mark from Medicare on a quality report. But it won't be that great doctors aren't doing a great job, just that they are not putting the systems in place to manage it."  

When it comes to quality improvement in general...

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