Wound Care Articles and Insights
August 23, 2016

Value-based Incentive Payment Overview

Melissa Bailey

By what metrics do you think you should be paid for the care you provide to your patients?  Medicare thinks it should not be measured by volume.  And there it is; the calculated demise of the Physician Fee-For-Service payment model.

Medicare reimbursement is migrating to a value-based care model anchored on both quality outcomes and cost of care.  After all, Medicare is by most measures a government based insurance company; and in some ways our virtual employer.  The practice of medicine should decisively be at the professional discretion of the physician.  However, with Medicare recipients, it is Medicare who ultimately decides if the decisions the physician makes warrants the remuneration the physician is requesting for his/her services. 

Like any business seeking to remain whole and potentially profitable, both quality and cost are vitally important.  For that reason, value-based care is Medicare’s vision of achieving the best outcomes at the lowest cost. 

As stated by the Secretary of Health and Human Services “30% of Medicare payments should be tied to quality or value through alternative payment models by 2016 (50% by 2018)”. 

This statement is supported by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), signed into law by President Obama on April 16, 2015.

What this means to you as healthcare practitioners in an outpatient wound care setting:

  • Responsibility for rendering value-based care to a patient population often afflicted by a multitude of comorbidities 
  • Management of these complex patients beyond routine wound care    
  • Capturing the severity of illness imperative to the value-based model
  • Accurate EHR documentation assuring optimal reimbursement for Medicare recipients

The ICD-10 conversion supports the level of codes necessary to capture the severity of illness of the patient population.  Without the appropriate documentation and ICD-10 code allocation, Medicare has no way of assigning value to the patients seen in wound care centers.   Consideration for value-based reimbursement will be determined by the cost and quality of care rendered correlating with the severity of illness of the patient.

The disdain for escalating documentation and electronic health record requirements is palpable, and for good reason.  Time will always be at a premium for healthcare providers.   The WCA Luvo EMR system streamlines your documentation process while capturing the necessary coding and documentation requirements to meet the Medicare value-based care programs.

Future blog posts will provide greater detail as CMS moves away from the current Physician Fee-For-Service model and progresses toward a value-based reimbursement system.

~Terrie A. Dittmeyer, RN, BSN, MBA                                                                                                                                                                                                                                                                  


We Support
Wound Centers.

It's just that simple.