​ Pedoscope August 2016 - Summer Musings – The Future of Healthcare

Summer is often a time for reflection as you’re sitting on the beach swatting away flies that aren’t there, a time to dump your memory cache, a time to defragment your mind.

Time to think about the direction your career or business is taking after navigating the recession we’re told is over. As you focus on the horizon while you are on shark patrol duty, you might have a few spare moments to ponder what does the next twelve months hold for your career. What are the choices you need to consider? What are the decisions you need to make?

We are bombarded every day with so much information to absorb that sometimes it can just seem overwhelming. Choosing the right path is always life changing decision. If you are a private practitioner or small business owner in the foot care health-care arena then I wish you well in choosing the best path, for you.

The Future for Healthcare Providers: Value-Based Reimbursement
Last year’s passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the sustainable growth rate formula to update Medicare payment rates and replaced it with a new model to reward quality care.

Learning to dance in the Macra arena will be here sooner than you think. Medicare is set to launch its Merit-Based Incentive Payment System (MIPS) next year, sometime in 2017. MIPS will factor value and not just services performed when considering the Medicare reimbursement a provider receives. Private insurers are likely to follow. It’s generally considered the model for the future of healthcare.

Beginning 2019, (but based on 2017 data) provider payment updates will be influenced by four metrics; quality, resource use, clinical practice improvement and meaningful use of electronic health records (EHR). MIPS will determine whether there is a plus or minus adjustment made to the services you’ve provided to determine ultimately what you are paid.

But there is another option and perhaps one that could help smaller practices really grow their business.

Joining an Accountable Care Organizations (ACO’s) such as a hospital or larger medical group exempts providers from MIPS participation and they could also receive an annual 5% bonus payment. For some practitioners, finding an ACO in your state to join may prove a challenge, but joining one will increase patient referrals considerably and help integrate practitioners as an indispensable component of the allied health care continuum. It could actually be a good thing for a stand-alone practitioner.

Those practitioners that plan to embrace MIPS will benefit the most from the financial incentives for delivering quality care at lower costs. It’s true that payers are looking for ways to control costs, but they also need to work with providers offering those services required by their insured.

For more information on the Future of Medicare’s Therapeutic Shoes for Diabetics program as it relates to ACO’s click here for an article I wrote earlier in the year.

MIPS or ACO? It’s a toughie. It’s the sunset of one era and the sunrise of another.

I'd love to hear from you, so if you have any feedback, please don't hesitate to reply to this email.

Thanks for reading and I hope you have a great rest of your summer.
Steve O'Hare

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