The typical reimbursement for medical providers is called a Fee-for-Service model this is where providers are paid for the services they provide, with no real oversight as to how the patient is progressing or improving, other than requests for records after a certain length of time to confirm medical necessity.
The carriers have already put into motion payment methodology called Value-Based Care, with the goal of improving patient outcomes and rewarding providers that show meaningful improvement of their patient’s health, not for the volume of services they deliver.
When did this start?
Now, this didn’t happen overnight, it’s actually been happening since 2000, with pilot programs of Physician Group Practice model and Accountable Care Organizations. From 2000-2010 CMS then started incorporating clinical data and cost predictions into payment models. In 2011, the ACA implemented reforms in bundled payment methodologies and pushing to a value-based systems, MIPs (Merit Based Incentive Payment Systems) and APMs, (Alternative Payment Models, which are currently being used in the Medicare system. In fact, CMS has a goal to transition ALL traditional Medicare Fee for Service beneficiaries and most Medicaid beneficiaries over to accountable care relationships by 2030.
What does this mean for the average provider?
It means that documentation that supports the rationale for your treatment AND outlines patient improvement will be mandatory for payment. This can actually be good for holistic professions as the core goals of a VBC model are:
• Focusing on person-centered, holistic approaches to enhance healthcare experience
• Using evidence-based, preventive care to improve outcomes
• Minimizing unnecessary interventions, hospital admissions and duplicate services
• Integrating community resources to address Social Determinates of Health
It is clear the future of reimbursement will be tied to outcomes and performance, NOT volume. It’s already happening with Medicare and as we know, it starts there, at the top, and then carriers adopt those same policies. It is also known that VBC relies heavily on data collection and analysis to track patient outcomes. This means that your documentation will be MORE important than ever. Creating treatment plans and goals of treatment, using standardized measurements and most importantly documenting improvement will ALL be required for payment. VBC is not a one-time project, rather it will require regular performance reviews.
To this end I am putting the final touches on my updated Documentation for Acupuncturists Seminar. I have updated resources, templates and materials.
If you are not 100% confident when asked for notes you will be eaten alive with this new model. Ask anyone who’s been in practice for a while, notes are being requested more and more, and that’s just the first step.