Start thinking now about how your practice will change when value-based reimbursement becomes the norm, Dr. Madelaine Feldman advised at the annual Perspectives in Rheumatic Diseases.
It’s important “to have an idea of a pathway that they’d like to go down 4 or 5 years from now, and preparations need to be made,” Dr. Feldman of the department of medicine at Tulane University, New Orleans, said in an interview. Dr. Feldman also serves on the board of directors of the Coalition of State Rheumatology Organizations.
Dr. Madelaine Feldman
And she stressed that this is not going to be just a government thing.
Some doctors seem to think, “Well, maybe I will just opt out of Medicare and everything will be fine.” That won’t be workable, she predicted. “The private payers are all going to be value-based as well.”
But for now, little information is available on how the alternative payment models will work and whether following that or building off the federal government’s Merit-Based Incentive Payment System program will be the way to go.
“We don’t have any definitive answers or a real clear pathway for physicians. Most are just ... trying to make Stage 2 of Meaningful Use [work] and all of this is getting thrown at them,” Dr. Feldman said at the conference, held by Global Academy for Medical Education. Global Academy for Medical Education and this news organization are owned by the same parent company.
However, one thing is clear: Cost “is going to be so important in terms of your reimbursement,” and that is something she said doctors should start thinking about now.
“High resource utilizers are going to get penalized, and I think that’s something that probably hasn’t sunk in to a lot of physicians’ mindsets,” she said.
In particular, utilization of drugs under Part B versus Part D may become an issue, Dr. Feldman said, because the Centers for Medicare & Medicaid Services currently ties Part B prescribing to the individual prescriber; it does not do the same for Part D.
“For rheumatologists, this is a huge issue because all of the drugs cost a lot of money. If you infuse in your office, you are going to be dinged [as a high resource utilizer] because those are [paid for by] Part B,” Dr. Feldman said. “If you send [patients] to an outlying infusion center, you probably won’t get dinged for it. But if you prescribe self-injectables, the cost is going to be just as high but you won’t get dinged for it because it is Part D.”
She noted that could change in the future as regulations for value-based payments begin to take shape.
Dr. Feldman reported no relevant conflicts of interest.