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20k+ Physicians Involved in the Launch of the ACA’s Fee-For-Value Program

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A block of federal guide lines for the healthcare industry are set to be enacted in the upcoming year, and will influence the direction of most medical practitioners for at least the next five years.  The concept behind this plan is to change providers from the Fee-For-Service (FFS) template (currently in use by the majority of healthcare facilities) to a Fee-For-Value (FFV).  The initial trial will affect some 20k+ Doctors and over 24 million patients across the nation.

This represents the beginning of a fundamental shift from the FFS protocol.  The FFS model is used by healthcare providers to charge separate fees for all the different procedures it takes to treat one case.  By breaking up the services, physicians are incentivized to produce quantity of care over patient healthcare quality.  In the most callus essence, the Healthcare Provider does not necessarily look at a patients long term wellbeing, but merely at the money that can be made by delivering the patient any number of procedures, services, or prescriptions.

The new system looks at the long term, overall health of patients and tracks a range of indicators to identify genuine improvements in population health.  The resultant changes that should range from moderate to extreme will eventually flow through to substantial cost savings for both healthcare service provider and the federal /state governments.  With the added benefit that a healthier population is generally more productive.  Thus, creating the virtuous circle of better real population health, lower expenditure on actual healthcare, and increased tax revenue.

The provision within Affordable Care Act (ACA) that allows this to function is the Medicare Shared Savings Program (MSSP).  This program is broken up into 2 tracks.

Track One: will continue to use the fee-for-service model, however – a monthly care management fee will be added under the Medicare Physician Fee.  This, being a moderate plan to save money over a gradual period of time.  The care management fee can be used to identify the most at-risk patients, and slowly begin educating them towards better lifestyle choices.

Track Two is the more aggressive Shared Savings and Shared Losses for All Years of the Agreement.  This is expected to appeal to healthcare systems (ACO’s) and individual physicians groups that have already implemented their Electronic Medical Records (EMR) completely and have (most likely) layered in advanced healthcare data analytics.  The combination of which creates the opportunity for identifying many more unnecessary procedures; over prescription situations; shifting to use to more generic drugs, and devices; higher physician efficacy rates; educating at-risk patients; lower readmission rates; and proactively lowering total healthcare costs.  This program allows those organizations to look at a maximized return (but, also a shared risk of failure).  This track is expected to save the federal and state governments almost $2 billion (possibly significantly more) in annual cost reductions, according to Dr. Patrick Conway, CMS Deputy Administrator and Chief Medical Officer.

Regardless of the track chosen by providers, the potential to increase ACO/physician profitability, and improve patient health is likely to incentivize more and more healthcare providers to take part in these tracks, which as of now, are voluntary plans.  Despite the fact that the proposed plans are not mandatory, it is expected to have 50% of the current fee-for-service model users involved in either track one or two by 2018.  A situation that will hopefully continue to improve as the years progress.

Article created by Bettsy Farias, Researcher, Global Healthcare IT, Inc. and edited Michael Williams, CEO, Global Healthcare IT, Inc.