Value/Outcomes-based Reimbursement on Derm

[charmiedermie]

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Anyone know how greatly Derm will be affected by new Medicare rules tying reimbursement to value/outcome rather than fee-for-service esp on Dermpath and Mohs?

Its been happening for a while but the apparent goal by HHS is to have 90% of Medicare payments tied to quality/value by 2018.

www.hhs.gov/news/press/2015pres/01/20150126a.html

 

[Slack3r]

Your income will almost certainly go down.

 

[asmallchild]

Anyone know how greatly Derm will be affected by new Medicare rules tying reimbursement to value/outcome rather than fee-for-service esp on Dermpath and Mohs?

Its been happening for a while but the apparent goal by HHS is to have 90% of Medicare payments tied to quality/value by 2018.

www.hhs.gov/news/press/2015pres/01/20150126a.html

What slacker said.

The problem with such a plan is that it requires a quality reporting system. That might work well for medical conditions like DM or CHF but you'll find that doesn't work so well for many conditions we see in dermatology. It will be interesting to see what this means in terms of payment for dermatology services but it's unlikely to be as favorable to us as fee-for-service.

 

[charmiedermie]

What slacker said.

The problem with such a plan is that it requires a quality reporting system. That might work well for medical conditions like DM or CHF but you'll find that doesn't work so well for many conditions we see in dermatology. It will be interesting to see what this means in terms of payment for dermatology services but it's unlikely to be as favorable to us as fee-for-service.

But who would set those outcomes? Medical specialty societies? HHS? I would think DM and CHF would be hard to pay for outcomes largely bc of patient compliance.

 

[asmallchild]

But who would set those outcomes? Medical specialty societies? HHS? I would think DM and CHF would be hard to pay for outcomes largely bc of patient compliance.

That's the problem with outcome-based reimbursement. Who sets the outcomes? How do we factor in patient compliance? You at least have a HgbA1C or ejection fraction to go by in other conditions. It won't be an easy transition and whatever the result, I don't see this benefitting dermatology.

(At least in the JAAD, I have noticed a transition over the last 3 years where many academic institutions are really pushing the use of a classification system. PASI for psoriasis, CLASI for lupus, I'm sure there's a system of some sort for acne, etc. It helps to turn a visual diagnosis into a number that we can compare but I question who really uses these systems outside of academics)

 

[charmiedermie]

That's the problem with outcome-based reimbursement. Who sets the outcomes? How do we factor in patient compliance? You at least have a HgbA1C or ejection fraction to go by in other conditions. It won't be an easy transition and whatever the result, I don't see this benefitting dermatology.

(At least in the JAAD, I have noticed a transition over the last 3 years where many academic institutions are really pushing the use of a classification system. PASI for psoriasis, CLASI for lupus, I'm sure there's a system of some sort for acne, etc. It helps to turn a visual diagnosis into a number that we can compare but I question who really uses these systems outside of academics)

I honesty would have thought medical specialty societies since the federal govt. knows nothing about properly assessing and evaluating diseases bc they don't have medical knowledge. Similar to the RVU committee.

Any input @MOHS_01 and @Dral on the effect on Mohs and Dermpath?

 

[MOHS_01]

We are trying to work our way through this right now - more when I get something to report. Odds are we won't be seeing any positive pay bumps, though.