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Small Practices Forging Ahead in Value-Based Care

Small Practices Forging Ahead in Value-Based Care

There is a lot of skepticism in the physician world on whether or not "value-based care" — where providers are reimbursed based on quality measures, rather than quantity — can work.

In an upcoming, yet-to-be-released survey from Physicians Practice, more than 50 percent of physicians (1,314 were surveyed) said value-based care was a good idea in theory, but difficult in practice. A smaller group, approximately 20 percent, went so far to say that it was a bad idea that would never succeed. Only 6 percent of respondents said it was a good idea and good for patients.

For full results from our 2016 Great American Physician Survey, visit PhysiciansPractice.com in early September.

Yet despite the fact that value-based care may not be winning the hearts and minds of physicians across the country, CMS is attempting to do just that before those doctors have to get on board. The agency recently proposed a rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), mandating two tracks for physician reimbursement — the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

Most physicians will fall under the former, where they'll be scored on quality measures, usage of technology, clinical improvement, and cost utilization. APMs require participation in Medicare-based payment models such as accountable care organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). In the past few months, CMS has spent a copious amount of time to get physicians on board, through webinars, speeches from officials at professional meetings, and more.


For physicians, this upcoming reality means there is simply no avoiding value-based care. Clive Fields, physician and owner of Houston-based Village Family Practice, says, "CMS has said by 2018, 70 percent of Medicare patients will be in value-based arrangements." Fields, who runs a side business consulting practices on implementing value-based care models, adds most physicians are in these kinds of arrangements already, possibly through Medicare or a private payer. "They are in value-based contracts; I promise they've all signed up for value-based incentives. They aren't doing anything with them because they're all focused on fee for service."

While many practices are sitting idly by and ignoring value, there are some small practices taking a more proactive stance by not waiting for the MACRA hammer to drop. Physicians Practice spoke with four small practices that have dabbled in value-based care, one way or another. They shared with us the benefits and challenges of value-based care as well as advice they have for their peers.

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