Pay-for-performance is undoubtedly on the rise, but the road map for constructing new payment models is still relatively weak, according to Jen Johnson, partner at VMG Health, a healthcare valuation and transaction advisory firm.
"We're in the middle of fee-for-service going to value-based purchasing," she said. "It's a blend. It's a weird time."
At the Becker's Hospital Review 5th Annual Meeting in Chicago on May 15, Ms. Johnson offered the following three tips for providers looking to start developing pay-for-performance models while still remaining compliant with government regulations concerning reimbursement.
1. Start with a "modest" set of metrics as the basis for the model. Ms. Johnson advised looking at the metrics Medicare and commercial accountable care organizations are already using. Providers should also consider who they're serving. "Ideally, you want what the patient population needs," she said. Metrics should also be rebased annually.
2. Determine the flow of funds in advance. "They want the models set up in advance so you can't mess with it later," she said of regulators. "You want to set up the structure first."
3. Put yourself in the Office of Inspector General's shoes. "It's complicated because there isn't a road map, but it's just common sense," Ms. Johnson said of compliance. She advises providers to "put your operational hat on" and ask if a pay-for-performance model makes sense and could be explained in court.
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