3. Expect to be measured – no more “invisible man (or woman).” The Physician Quality Reporting Initiative (“PQRI”) program was expanded in ACA, so that there are increasing incentives to participate through 2014, then the penalties for non-participation begin (sense a theme here?). Results will be posted publicly on the to-be developed “Physician Compare” website sponsored by CMS. This is in addition to the data gathered by payers and other private rating websites such as HealthGrades. Whether or not the measures are “right,” they will be published and available to consumers. The forward-thinking physician organizations are collecting and sharing this information among physicians now to provide timely feedback and improve organization-wide performance and outcomes.
4. Are you now or have you ever been an ACO? ACOs will be selected by CMS beginning in 2012. Some private payers and self-insured employers are evaluating this model as a way to reduce healthcare cost inflation and improve population health. It is widely accepted that ACOs must be physician-led in order to achieve these objectives. Since the infrastructure required to function successfully as an ACO is substantial, many smaller physician groups will be participate in ACOs; others will be large enough to potentially qualify as an ACO. The key question for physicians to consider is: what role should/can we play in an ACO model, and what resources, leadership skills and partners will we need to successfully fulfill that role?
5. Would you like to be a pilot? The ACA calls for the funding of $10 billion to the CMS Center for Medicare/Medicaid Innovation to provide grants and lead demonstration projects to identify new delivery models and/or payment models. The hope is that through incentivizing discovery, new care delivery models such as the patient-centered medical home (“PCMH”) or payment models such as bundled payment will evolve to “reduce program expenditures while preserving or enhancing quality of care.” Alert physician organizations, large and small, can participate in these demonstration projects to be at the leading edge of innovation and seize opportunities to lead the market.