Can virtual groups help independent practices?
Most IPAs failed because they weren’t able to win better insurance contracts for physicians, he recalls. IPAs also promised to help doctors retain their independence, but physicians found they had submit to medical management for the IPA to thrive in the marketplace.
Today, LaPenna notes, very few doctors have access to “a working, effective, functional IPA.” While the model has had success in California, he says, it took decades for independent doctors in that state to learn how to work together in IPAs that took financial risk.
Despite past failures, IPAs can succeed in today’s market if they’re properly structured and managed, argues John Franco, MD, medical director of the IPA of Nassau and Suffolk Counties on New York’s Long Island.
He regards his 800-member IPA, which is affiliated with another IPA of similar size in New York’s Westchester County, as a kind of virtual group. His IPA, he notes, will help its members both report to MIPS and improve their quality of care.
“If a doctor wants to be an independent providing healthcare, he or she has to be part of something,” he says. “To go it alone is a challenge. An IPA is the solution.”
Accountable care organizations (ACOs) also can help doctors report under MIPS. Partly for that reason, Jennifer Brull, MD, and her four colleagues in a primary care group in Plainville, Kansas, recently joined a physician-owned ACO, one of many formed by Aledade, a management and technical services company.
The Kansas ACO includes about 45 doctors in 15 different practices, and Brull says she has “a large voice in how the ACO runs.”
Another reason why Brull’s practice participates is that the ACO provides strong health IT support.
“I can’t imagine how the tech would work in a virtual group,” she says. “I know how challenging the tech is for us, and we have tremendous support from Aledade. I can’t imagine how it would be easier for a group of doctors who have no affiliation to report [to MIPS] together. That would be the biggest challenge.”
Physicians need not rely on virtual groups to cope with MIPS or value-based reimbursement.
For example, some are having their EHR vendors report to CMS for them. Solo internist Edward Rippel, MD, of Hamden, Connecticut, says that his vendor configured his system so it could report his data “for a small fee.”
Moreover, he gets full credit for clinical practice improvement activities because he’s a patient-centered medical home. So Rippel doesn’t need to join a virtual group to report to MIPS, he says.
Doctors can also look to other methods of group reporting, such as qualified clinical data registries. Originally used for reporting to CMS’ Physician Quality Reporting System, most registries are operated either by specialty societies, specialty-specific or disease-oriented collaboratives, or quality improvement collaboratives.
The fees to use these registries are generally only a few hundred dollars per doctor per year, and experts in these organizations can walk practices through the reporting process. The main drawback of data registries is that they usually require manual data entry, although some registries are more automated than others. (For more information, see bit.ly/QCDR-info.)
Participating in a registry formed by a specialty society, Wynne says, is a good alternative for physicians who don’t want to join a virtual group. “If you’re a small practice,” he says, “participating in a clinical registry is going to be your best bet.”