Kara Nuzback - Texas Medicine Magazine
Physicians have for decades earned a living based on caring for the sick. But in the new world of health care, professionals will earn money based on whether they can keep their patients healthy — a value-based payment system.
Charles Stiernberg, MD, is chief operating officer at Hillcroft Medical Clinic (HMC), a multispecialty facility in Sugar Land.
"For years, we've been a predominately fee-for-service organization, much like most Texas doctors," he said. "It's just the way medicine has been practiced for decades."
But times are changing, and Dr. Stiernberg says physicians in the clinic recently started to consider how a value-based model could keep their practice vital.
"If we didn't cut our teeth on this and start learning about it, there may be a day in the future when we regret not having done so," he said.
David Spalding, a health care executive with 15 years in the industry, says value-based care models are rapidly replacing fee-for-service contracts. Ten years from now, a fee-for-service physician will retain only one of every five patients he or she cares for today, Mr. Spalding says.
"A doctor down the street who has acquired the tools to operate in this new market will have four out of your five patients," he said.
Mr. Spalding is chief operating officer of TMA PracticeEdge — a new services company that offers primary care physicians and specialists the technology and business know-how to help them compete with large health care systems, while retaining their independent practices.
With help from TMA PracticeEdge, Dr. Stiernberg and the physicians at HMC plan to form their own physician-led accountable care organization (ACO).
The Affordable Care Act established ACOs as voluntary groups of physicians, hospitals, and other health care professionals who accept responsibility for the overall quality, cost, and care of a defined group of Medicare beneficiaries. When Medicare saves money on services because a patient population is healthy, it splits the savings with participating ACOs.
According to the Texas Academy of Family Physicians (TAFP) fall 2014 article, "Embracing Change on the Border," a group of McAllen physicians who formed the ACO Rio Grande Valley Health Alliance saved more than $6 million in their first year of participation in the Medicare Shared Savings Program (MSSP), $3 million of which was theirs to keep.
And Medicare is not the only payer with a shared savings program; most private payers now offer value-based contracts. The catch is proving you kept patients healthy and saved the payer money, which can be a challenge. Medicare, for example, has more than 30 quality measures MSSP participants must satisfy. To read more about MSSP, visit tma.tips/MSSPbenchmarks.
In January, federal Health and Human Services Secretary Sylvia M. Burwell announced a goal to tie half of all Medicare payments to ACOs and other value-based models by the end of 2018.
That's where TMA PracticeEdge comes in.