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    Medicare pay reform, population health will disrupt RCM

    Small physician practices that participate in programs like the Merit-based Incentive Payment System (MIPS), or population health initiatives will suffer revenue cycle disruptions, as well as lost revenues as they seek to improve their pay-for- performance operations.

    This is according to David Nash, MD, MBA, dean of the Jefferson College of Population Health at Thomas Jefferson University in Philadelphia, Pennsylvania.

    Reflecting on the fact that both programs are based on variables that can change during the course of an episode of care such as cost, patient outcomes and quality of care, Nash said physician practices are left with a high degree of uncertainty about how much they’ll get paid after insurers analyze their performance metrics.

    “Unpredictability is the theme moving forward,” Nash said. “In both MIPS and population health initiatives, the revenue will be tied to outcome measures and the outcome measures are going to be complicated.”

    In the case of population health, which monitors and treats groups of patients with specific illnesses to improve outcomes among the group, Nash said the measures are going to be based on which insurance company’s population health program the physician practice joins.

    In the case of MIPS, he said we still don’t know how the Centers for Medicare & Medicaid Services (CMS) will score practices performance measures and what the impact will be on small practices and their revenue cycles. MIPS is one payment track under the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA).

    Physicians participating in MIPS, will send data to Medicare beginning January 1, 2018, and no later than March 31, 2018 to qualify for a positive or neutral payment adjustment, affecting their 2019 Medicare Part B payments, helping them avoid up to a 4% negative payment adjustment in 2019.

    As small practices seek to follow groups of patients more closely, collect data and change business processes to meet the components of MIPS  ̶  quality, improvement activities, advancing care information and cost  ̶   small practices will have to redesign their operations to meet performance standards.

    Next: Change means making investments


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