OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Jason Weisstein, MD, MPH, FACS.
An increasingly frequent concern is that the Merit-based Incentive Payment System (MIPS) and value-based care in general could lead to the demise of private physician practices. With the prevalence of that concern comes pressure for private practices to join Accountable Care Organizations (ACOs), where groups of doctors and/or hospitals synergize to deliver coordinated care to Medicare patients. ACOs certainly have their benefits, but the risks of joining one need to be evaluated as well. An ACO may work for one orthopaedic practice but not for another. From my perspective, private practices, both small and large, will be able to thrive under MIPS. Here’s why:
- First, the final ruling from MACRA has given physicians the ability to report with the ‘pick your pace’ model. The slow, phased introduction for MIPS gives practices a window of time to get on track. 2017 is the transitional year, giving practices time to identify processes and an EHR system that best fit their needs.
- Second, CMS established flexible MIPS measurements based on practice size. (Small practices are typically considered to be those with ≤15 providers, and large practices have >15 providers.)
- Third, if you have the right support from your vendors—especially your EHR system vendor—you will have a built-in MIPS intelligence platform, composite scoring, and support and advisory services to help you along the way.
- Finally, the government has earmarked an extra $500 million for “exceptional performance” for each year of the first five years of MIPS. The right EHR system can direct and support you to achieve this exceptional-performance rating.
Ultimately, the decision to join an ACO or remain a private practice is a multifactorial one. You should consider the options available and how they will impact you, both in the short term and long term. Either way, value-based care is here to stay, and finding an EHR vendor with the best resources for your practice is a crucial component for success.
Jason Weisstein, MD, MPH, FACS is the Medical Director of Orthopedics at Modernizing Medicine.
The 9th annual Epocrates Future Physicians of America Survey from athenahealth polled more than 1,400 medical students about clinical teamwork, among other topics. A whopping 96% of respondents said that collaborating with “extended care teams”—members of which might include nurses, PAs, and medical staff—is important or very important to the delivery of high-quality care. Forty-three percent cited fragmented care as the number-one risk factor for compromised patient safety, with cost of care and medication non-compliance coming in a distant second and third, respectively. And, apparently aware of the shift toward financial incentives for better outcomes arising from team-based care, 67% rated care coordination as important or very important for a physician’s financial success.
However, 57% of respondents cited inadequate cross-team communication as the number-one barrier to coordinated care, with a lack of interoperability among current EHR systems cited by 42% as the primary hurdle. On a more positive note, the survey found that 86% of respondents felt that their medical training prepared them for patient-centered care, a model that stresses patient and family involvement in shared decision-making.
The survey also asked students about their awareness of accountable care organizations (ACOs). According to the American College of Physicians, “the core purpose of an Accountable Care Organization is to provide accessible, effective, team-based integrated care.” Yet, according to the survey, 65% of medical students feel they don’t know enough about ACOs. That’s down from 72% in last year’s survey, but it’s still a sizable proportion. Another 39% admitted that they are unsure about the purpose or structure of ACOs.
In two miscellaneous findings that reveal ambivalence among medical students regarding the personal versus technological in medical practice, 99% of respondents said they would prefer a face-to-face office visit over a virtual encounter for an initial patient interaction, while at the same time 97% said they would encourage patients to use remote monitoring devices such as those now available for tracking weight, physical-activity levels, blood sugar, and vital signs.