ICD-10 Delay and Medicare Payment Reform

JustinBarnes14Control Your Own Destiny — Stay Vigilant to Organizational Strategies for Success

By Justin Barnes, VP, Greenway Medical Technologies
Twitter: @HITAdvisor

Whether the ICD-10 delay and Medicare payment fluctuations bring relief or frustration, there are still many ways to position your organization for a successful future.

In fact, despite the recent disposition toward delay, now is actually the time to energize or re-energize your focus on existing programs that create a strong foundation for evolving and future value-based and alternative payment incentive models, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).

As you may know, the congressional stalemate on how to pay for long-term Medicare payment stability — coupled with the phasing out of fee-for-service (FFS) — brought ICD-10 into pre-midterm election politics. The result? A one-year delay of the advent of ICD-10 in the U.S. until Oct. 1, 2015. In addition, a one-year Medicare payment patch averted a 24-percent cut, instead increasing Medicare payments by 0.5 percent for the next 12 months.

Both actions temporarily slowed the momentum of the SGR Repeal and Medicare Provider Payment Modernization Act (SGR Repeal), which proposed to stabilize Medicare payments through 2018 and that same year institute a value-based purchasing program similar to accountable care structures while phasing out FFS.

Moving your healthcare organization forward
Keep in mind that throughout this process, congressional leaders said they will still work hard to resurrect the bipartisan SGR Repeal Act widely supported by Capitol Hill, provider groups and the health IT industry. This is the right thing to do to advance preventive, coordinated care and move toward a sustainable healthcare system.

In the case of ICD-10, many organizations were readying for the conversion this fall, respecting its merits toward advancing quality reporting, expanding performance measures and improving overall population health.

You can make the most of these changes by staying focused on creating strategies for implementing the value-based and alternative payment incentive models the SGR Repeal Act proposes:

Accountable care organizations — With more than 600 voluntary structures currently operational, many of your peers have moved into coordinated care programs based on quality incentives. Don’t be left behind. These programs are another example of how private payers and healthcare organizations have followed the lead of the original Medicare Shared Savings Programs.

Patient-centered medical homes — This equally successful program has been expanded to include specialty medicine, with the March 2013 launch of the Patient-Centered Specialty Practice (PCSP) program by the National Committee for Quality Assurance (NCQA).

Meaningful use Stage 2 — Stage 2 is an example of how quality measure incentive programs will come to pass. Keep in mind that for the 2014 reporting year, any 90-day or fixed-quarter attestation can be pursued, so there’s plenty of time to capitalize and ready your organization for success. There are incentive funds still on the table.

With aspects of healthcare coverage, payment and sustainability such a paramount issue for our country — intertwined with health IT adoption and improved population health goals — it’s essential to continually assess what programs are best for your organization and your patients.

It’s safe to say you will need to engage these programs despite periods of fluctuation to successfully compete in a future of healthcare dominated by accountable care, value-based purchasing and alternative payment models.

About the author: As a healthcare software executive and public policy advisor, Justin Barnes is a Vice President with Greenway Medical Technologies and manages Greenway’s Industry Affairs and Government Affairs departments. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS Electronic Health Record (EHR) Association as well as Co-Chairman of the Accountable Care Community of Practice where he assists both organizations with industry strategy and leadership.

This was originally published on the Greenway Blog and is syndicated with permisssion.