Why 2016 will be pivotal in practices' transition to value-based care [Interview]

The past year has been full of changes that will affect physician practices for years to come. For insights into what will matter most to practices in 2016, we turned to Reid Blackwelder, M.D., immediate past president of the American Academy of Family Physicians.

In an exclusive interview with FiercePracticeManagement, Blackwelder shared his thoughts on the impact of the shift to value-based care in general and the Medicare Access and CHIP Reauthorization Act in particular.

FiercePracticeManagement: What do you foresee as practice managers' key concerns for the coming year?

Reid Blackwelder (pictured): There are several, but one of the foremost areas for physicians and practices to stay informed surrounds how the shift away from fee-for-service (FFS) toward value-based payments will actually manifest.

While it's encouraging that legislators and payers are saying they're going to pay for value, the challenge for us is going to be determining how value is defined. How is CMS going to be looking at the value-based shifts that they promised? How does it take shape under MACRA? This is uncertain right now because we don't have all that information together--and that is a big thing within the next year, especially since MACRA is really going to start in 2017.

We really need to be aware of the process, as 2016 is going to be a pivotal year for folks in terms of practice management and making the choices--about whether to go with an alternative payment model or the merit-based incentive payment system--to make sure your practice is viable in the years to come.

FPM: So we have the language but it's not yet fully defined?

RB: Yes, and that is scary. Another frustration I think physicians will be wrestling is that while MACRA of course got rid of the SGR, thank goodness, we just learned that instead of the 0.5 percent update that was supposed to start next year, we're going to have a decrease in 2016 because CMS was unable to meet a threshold for identifying overvalued codes.

So another big issue for the coming year will be pushing CMS as well as Congress to ensure that efforts are made to address the challenges in the FFS model, especially with respect to the longstanding undervaluing of primary care.

Organizations are more likely to make an impact there than individual physicians, but individual physicians need to be aware of that component as well.

FPM: What can physician practices look forward to most in the coming year?

RB: A real positive is that our academy, beginning over 10 years ago, really pushed the concept of the patient-centered medical home (PCMH). I know that's an acronym that can still push people's buttons, but if you really look at the tenets of that--which is not necessarily an NCQA accreditation but a principle--we can change the way we deliver care to be more patient-centered.

The encouraging thing is that across the country, the conversation around PCMH continues. And being a PCMH, however that might be defined in your area, has value in terms of MACRA because it's counted as an alternative payment model.

Those practices that have already moved toward transforming are looking at what we feel is the positive side of MACRA, which allows you to be in a position to continue to take advantage of things like chronic care management fees and many of the other things that are sort of waiting for physicians to really take advantage of.

One way you define value is with better outcomes for patients and better satisfactions for patients as well as providers, and I think we're definitely making strides with that. - Deb (@PracticeMgt)