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    Top four healthcare industry changes to watch in 2017

     

    Reimbursement changes

    Louis J. Goodman, PhD, CAE, executive vice president and CEO, Texas Medical Association, and past president, Physicians Foundation, does not expect many significant changes in physician payment in the first quarter of 2017.

    One reason is that MACRA final rules provide for a one-year transition with a minimal data submission requirement. Goodman does, however, expect major challenges as physician payment migrates to value. “The 2017 MACRA Quality Payment Program (QPP) transition year will be a critical year for physicians and healthcare executives preparing for full implementation of the QPP in 2018,” he says. “Additionally, decisions will need to be made on which track to report Medicare data: Merit-based Incentive Payment System (MIPS) or APMs.”

    Goodman believes physician organizations will express strong dissatisfaction with the current bonus and penalty structure of QPP as they continue to advocate for reduced regulatory burden, restoring the ability of physicians to own hospitals, national professional liability reform, and additional protections for private practice.

    On another front, a significant national reimbursement issue is the current recommendation by The Medicare Payment Advisory Commission to combine Medicare Parts A and B—especially considering that hospital costs are attributed to total physician spending under value-based systems that employ population management technology, Goodman says.

    Another reimbursement-related issue that Valerie Barckhoff, principal and practice leader for Healthcare Advisory Services, Windham Brannon, foresees in 2017 and beyond is organizations’ readiness for bundled payments. The proposed rule on CMS’ new episode payment models has a go-live date of July 1, 2017. “This will be a significant data analytic opportunity for healthcare organizations as they will have unprecedented access to healthcare data across the continuum,” she says. “The need to understand the episode spend and identify opportunities to reduce Medicare’s costs to improve an organization’s profit margins are critical in 2017.”

    Regardless of any changes, Philo Hall, associate, Health Care and Life Sciences, Epstein Becker Green, says providers working with public and private payers can expect to face either lower fee-for-service rates or more demands to take risk (e.g., capitated payments, APMs), or both. “Executives should be cautious to not take on risk for costs that are outside of their control and therefore seek partners who can help them increase efficiencies and spread risk,” he says.

    Goodman says technology will play an ever-increasing role in healthcare delivery; strong oversight of electronic health record vendors and the reliability of their reporting to governmental and non-governmental entities can make the difference between penalty and bonus payments in the new MACRA environment.

    Next: Consolidation changes

     

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