Plan for Value-Based Purchasing Program Underway

On Dec. 9, the Centers for Medicare & Medicaid Services (CMS) held a public listening session to discuss the development of a plan to transition to a Medicare value-based purchasing (VBP) program for physician and other professional services. CMS’s internal PVBP Workgroup released an issues paper outlining the agenda prior to the event.

Design issues discussed during the event and up for public comment until Dec. 16 included overarching questions, measures, incentive structure, data strategy and infrastructure, and public reporting — everything the PVBP Workgroup is charged with as they develop the VBP Plan.

“Is it desirable to have several different approaches to accommodate different practice arrangements across various care settings?”

That was just one of the overarching questions up for debate. The assumptions and design principles indicate that the Plan will accommodate different practice arrangements, such as multi-specialty groups, single-specialty groups, small practices, and institution-based practices.

Among the several questions that pertained to measures, CMS asked: “Which quality measures should be used in the PBVP?”

Possibilities include clinical effectiveness process measures, outcomes measures, structured measures, and the ambulatory CAHPS tool.

On the topic of incentives, CMS posed the question: “How large does the payment incentive need to be to achieve the goal and objectives?”

The goal of the Plan is to “Improve Medicare beneficiary health outcomes and experience of care by using payment incentives and transparency to encourage higher quality, more efficient professional services,” as stated in the issues paper.

And a question on everyone’s mind lately — “How might various forms of data submission reduce the burden of reporting?” — was just one of the questions that dealt with the Plan’s data strategy and infrastructure.

There are three core models for the collection of measurement data: claim submission, clinical data submission, and claims augmented with clinical data submissions. Regardless of the model, CMS said, data challenges exist.

Which brings us to the final topic on the agenda: public reporting. “It will be the vehicle for CMS to provide useful, understandable, and actionable information about professional performance to interested stakeholders, including professionals, other providers, beneficiaries, other consumers, private health plans, and other purchasers,” CMS said.

The question is: “At what level should information be reported?” Better yet, “What information should be reported?”

Finding the answers to these questions could take time, but time is limited.

The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, Section 131(d) requires the Secretary of the Department of Health and Human Services (HHS) to submit a report to Congress containing a plan with recommendations for the transition to a VBP program by May 1, 2010.

Using input gained from the Dec. 9 public listening session, the PVBP Workgroup will formulate a set of design options and, subsequently, work toward the goal of presenting a final report to Congress.

For more details, read the complete issues paper on the CMS Web site.

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