The Sack of Rome in 410 AD – The Sack of Fee for Service, Now
By Denny Flint
Advisory Board, Advanced Medical Services
Director of Operations, Specialty MedCare and Peak MSO
Aided by rebellious slaves, Alaric I and the Visigoths rushed through a Roman city gate. The three-day siege was the first time in centuries (800 years) that Rome had been invaded and eventually sacked. It was a massive political and psychological blow and the city was caught off guard. Unexpected meant unprepared for the Romans.
Unexpected? We can’t say the same for the advent of value-based reimbursement. Beginning with the early forms of quality reporting, we’ve been marching inexorably to the beginning of the end for traditional fee-for-service reimbursement. ICD-10, Meaningful Use, EHR incentive programs, and PQRS were all stepping stones for the movement towards alternate payment models (APMs). Unlike the ICD-10 transition with its years long plethora of stops, starts, and delays, the new models (APMs) are surging through our gates like a blitzkrieg. CMS is actually ahead of the 30% fee for service replacement they planned by the end of 2016. They are highly motivated to get this done in short order because if they know one thing, it is that they will save even more money than forecast because most health care providers will ignore what needs to be done until the change is forced down their throats. And by then, it’s too late. Too late to make the necessary modifications to care delivery. Too late to collect the required history of data. Too late to change treatment protocols to a “less is more” focus.
The point is, this sea change in reimbursement method, though not unexpected, catches most health care organizations unprepared and off guard. One certainty? Just as Rome was sacked, so too is the rapid sack of traditional fee for service. Some of you may be thinking, “No big deal…I’ll just read the new regs and figure it out.” Have any of you actually read the CMS guidelines for all the new acronym models? We’re talking about MACRA, MIPS and all the other APM’s flowing into the system. Trying to understand EXACTLY what you have to do to prepare gets lost in trying to understand EXACTLY what in the heck these things are.
For the past five years I was on the road preaching about ICD-10 and how you have to do it not just for coding but for the future of your practice. Why? Because it was a stepping stone – we saw this coming. I would talk about ACOs and value-based reimbursement and people would look at me like I had two heads. Now you can’t be on twitter or LinkedIn without seeing articles about VBR models.
What I want to accomplish with this series of blogs is similar to what I did for ICD-10 when I was on the ICDMonitor Editorial board and writing articles for many top medical societies and healthcare journals around the country. I want to give you valuable information with a concise and hopefully engaging delivery.
I will start with background information about MARCA and MIPS then move into defining the different types of alternate payment models. I will discuss the payer movement towards APMs and what practices are doing right now. I will discuss which industries are ready to assist you with good data for participating and which are not. Finally, I will give solid advice on how you should prepare your practice to participate successfully within these new payment models. I’ll give you a hint. Actionable data (Quality and Financial) that can only be gotten from an EHR set up to collect that data will have a HUGE impact on your ability to weather this storm. There are only a handful of health tech companies out there that have already retooled to be a partner and not a hindrance. Advanced Medical Services billing and revenue cycle company is one of them. Hopefully, you’ve had “the talk” about APM with your current vendor. If not, please do so soon!
Stay tuned for my upcoming series about Value Based Reimbursement: Payment Models Are Changing – Be Prepared!
In the words of Henry Wadsworth Longfellow “All things must change to something new, to something different.” Expecting change is the one true constant in our industry. How you deal with this change will make all the difference.
Denny Flint
Director of Operations Specialty MedCare and Peak MSO
Advisory Board, Advanced Medical Services
dflint@admedserv.com
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