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Volume-to-value transition underway in orthopedic care
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During the last several years, a seismic change has occurred in health care payment and delivery, shifting the focus from volume-based to value-based reimbursement. In value-based care, providers are rewarded for the kind of care they provide, not how much they provide.
The shift began in 2007 when CMS established the Physician Quality Reporting Initiative under the Tax Relief and Health Care Act of 2006. The goal of the program was to improve health care in the United States by collecting and evaluating meaningful quality data.
Now called the Physician Quality Reporting System (PQRS), the program is just one part of a multipronged approach aimed to improving the quality of U.S. health care. The meaningful use electronic health record (EHR) incentive program and the value-based modifier are two other critical components.
“[Secretary of Health and Human Services] Sylvia Burwell has been public about her desire for physician reimbursement to be based on alternative measures, like value-based pricing and value-based reimbursement up to 90% by the year 2018,” John M. Tokish, MD, told Orthopedics Today. “I think most surgeons understand that we are going to be graded on what these outcomes are.”
Click here to read the full story in the June issue of Orthopedics Today.