As we ring in the start of 2016, many of us in the healthcare industry are excited about the prospect of positive changes and new technologies that will emerge in the new year. For the people in charge of quality programs and pay for performance at physician organizations, however, the start of a new year may bring anxiety over whether the past year’s performance met targeted goals (and will result in higher payments) or whether the reports will indicate that money was left on the table, yet again.
Although the U.S healthcare system has been shifting away from fee-for-service and towards pay-for-performance based reimbursement for the past 10 years, the change is still happening faster than many physician organizations can take…meaning there inevitably will be some that are left scrambling when the payment implications take hold. Unfortunately, idle participation in pay-for-performance programs, including those run by commercial payers as well as CMS-administered programs, is often not enough to ensure good results. Physician organizations that want to succeed in these programs by meeting targeted benchmarks and earning top dollar will have to invest time and resources into fully understanding the program standards and requirements, monitoring progress over time, and making clinical workflow changes to ensure that the program-determined clinical guidelines are being met.
The first step towards successful participation in pay-for-performance programs is always learning about the various components of these programs and how those components may impact your organization. Pay-for-performance programs are often based on a common model that, when understood by physician organizations who are implementing them, can help with both evaluating program fit and ensuring success. To help make this education process as easy as possible, Able Health has put together a white paper that outlines the components of pay-for-performance programs and provides information that can help set your organization up for the future of healthcare payments.
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