What are value based care and pay for performance strategies for independent physicians?

The independent physician plays a key role in a patient’s health, but the independent practice often runs on a tight profit margin. Providing quality, value-based care while maintaining financial stability can be challenging for some smaller practices. The Centers for Medicare & Medicaid Services (CMS) encourages and rewards the move toward value-based care, but reimbursement can sometimes put a small, independent practice in a bind while waiting for that pay for performance.

CMS has recognized the value in the independent practice and wants to encourage smaller practice to remain independent. In fact, recent studies have shown that “small, physician-owned practices, while providing a greater level of personalization and responsiveness to patient needs, have lower average cost per patient, fewer preventable hospital admissions, and lower readmission rates than larger, independent- and hospital-owned practices.”

Independent physicians have several strategies available to them for providing value-based care and participating in pay for performance plans. Value-based care generally requires time beyond the office visit to manage chronic conditions or to follow up on care plans. Independent physicians may find that they are spending additional time communicating with patients or with other providers. This time is typically not covered by traditional billing codes.

However, CMS recently added ongoing care codes to reimburse independent physicians for that extra time. For example, code 99487 is assigned for treating medically complex patients with an increased reimbursement rate of $93.67. Population health management can add to the efficiency of treating patients with complex or chronic conditions.

Another strategy for the independent physician is to join an Accountable Care Organization (ACO). While the physician retains independence, joining the ACO enables the practice to take advantage of the power of the group. Independent physicians in ACOs may be able to participate in Medicare’s Shared Savings Programs, in addition to enjoying cost savings and collaboration with other members of the group.

CMS also recently launched the Small, Underserved, and Rural Support initiative to “provide free, customized technical assistance to clinicians in small practices.” The program offers program level support and practice level support for practices of 15 or fewer physicians, with priority given to those practices located in a rural area, in designated health professional shortage areas (HPSAs), or in designated medically underserved areas (MUAs).