Can virtual groups help independent practices?
Other observers question whether virtual groups will be able to offer practices the health IT infrastructure they need to report their data to CMS.
A virtual group, they note, would have to aggregate and standardize quality data from many different electronic health records (EHRs)—unless all of the practices used the same EHR, which is unlikely.
Because of the lack of interoperability among EHRs, such standardization would require a considerable investment in data mapping software and technical staff.
Yet CMS has said nothing about government subsidies for virtual groups, nor has it announced how groups will submit data.
Without subsidies, health IT for these groups might be prohibitively expensive. Michael LaPenna, MBA, a healthcare consultant for Grand Rapids, Michigan-based The LaPenna Group, recalls putting together a plan for a small independent practice association (IPA) affiliated with a hospital. The cost for IT staff and software totaled $800,000 a year.
Even with the hospital kicking in two-thirds of the cost, the doctors would have had to pay $500-$600 each per year, LaPenna says.
Financial risk management
The Government Accountability Office (GAO) recently released a report to Congress on how financial risk management firms and other kinds of organizations might be able to help small and rural practices with MIPS and other value-based payment models.
The report predicts that many small practices will be unable to make the transition to MIPS on their own because they lack the financial resources to invest in infrastructure. The report adds, however, that such practices could seek financing and technical expertise from outside partners. Among these potential partners are larger physician groups, nonprofit groups, private companies, IPAs, hospitals and health systems.
“Non-partner” organizations that provide a set of services without sharing risk include technology vendors, Medicare quality improvement organizations and regional extension centers, the GAO says.
Having small practices partner with or hire these outside organizations to help them cope with value-based reimbursement is “aligned” with the virtual group concept, Wynne says.
Paul Keckley, Ph.D., a health policy expert and publisher of the health policy newsletter The Keckley Report, speculates that CMS is looking at more than just having these virtual groups report performance data. The agency also wants virtual groups to help small practices improve care quality and take on financial risk, he says.
Déjà vu all over again
In Keckley’s view, virtual groups are essentially the same as IPAs, which grew rapidly in the 1990s before fading out.