A Fundamental Shift in Reimbursement

April 15, 2011

The Medicare Improvements for Patients and Providers Act of 2008 set the stage for a fundamental shift in the way CMS may eventually reimburse physicians for services provided to Medicare-covered patients. The plan is to transition payments into a value-based purchasing program with reimbursement based on efficiency and the quality of services provided, instead of the quantity of services provided.

Private payors are following suit. Eager to have employers and plan beneficiaries view them as fiscally responsible, payors are now placing an increased emphasis on how physicians can demonstrate quality outcomes, continuous improvement and sustained levels of excellence in the delivery of care. Private payors want to, and in some instances already do, use clinical and economic data to identify providers and practices that demonstrate quality and efficiency and then make reimbursement decisions accordingly.

This growing interest in achieving higher-value care has led to increased efforts to improve systems for measuring care, using these measures for quality improvement, and directly linking quality outcomes to reimbursement. Providers need to take action now to meet Medicare reporting requirements and growing expectations among private payors that providers demonstrate value, or possibly risk reduced reimbursements in the future.

The AGA Digestive Health Outcomes Registry™ can help. The AGA Registry enables participating clinicians to monitor patient care, track interventions, measure and quantify outcomes, and identify and address gaps in care. In essence, the registry is a powerful data-driven tool that helps providers to document the quality of care they provide to their patients and to demonstrate excellence to patients, CMS and private payors.

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