Juggling the Regs

June 21, 2016 Merrie Wallace

Today, providers are juggling various complicated regulatory and payment programs requiring them to publicly report on their outcomes, change care delivery practices and face penalties if they don’t meet certain goals (which account for a significant portion of their revenue).

Though they still need work, these legislative requirements will benefit the future of healthcare and community health, but are a challenging reality for providers. While hospitals have become accustomed to value-based payment, newer policies are a new concept for a growing number of healthcare professionals, including employed and contracted physicians.

I was talking with the chief quality officer from a leading health system just last week, who said that one of their biggest areas of focus is educating all of the different stakeholders across the continuum on what these new value-based payment policies mean for them. A burdensome task, to say the least.

For instance, a primary care or independent provider may have little understanding of what the new physician payment legislation (known as MACRA) means. There are varying levels of knowledge and awareness across the board on how these new regulations impact the frontlines of healthcare.

It got me thinking. How well-versed are providers when it comes to value-based payment policies? Do they understand who they will affect, are they tracking progress and is it clear how outcomes will impact their paycheck?

Navigating the maze of new regulations and legislative mandates takes up a significant amount of time – time that providers need to focus on patient care. With the performance evaluation period for new payment policies that will affect physicians and post-acute care providers beginning in 2017, healthcare professionals cannot afford to be uninformed.

That’s why various health system stakeholders are coming together to join QUEST® 2020, a program with a mission to inspire, support and guide health systems in embracing their skills to accelerate effective value-based care delivery practices across their organizations. One of the main goals is to help providers translate and comply with complex legislative mandates, as well as regulatory reporting and programmatic requirements.

It feels like 2016 just began, but 2017 is only six months away. Sure, new physician and post-acute care payment programs don’t actually occur until 2019 but did you know they are based on 2017’s outcomes?

Healthcare’s progression toward requiring value-based payment models presents a new dynamic for a broad scope of stakeholders, including nurses, regulatory experts, infection preventionists, physician leadership, community health experts, pharmacists and care management representatives.

Without a clear understanding of what defines “value,” and a process to track regulatory performance and create standards, success will be limited.

Health reform is an adjustment for both consumers and providers. Right now, one of the most important elements of this change is for providers to adjust to these new payment measures, which will also affect their public brand.

If you want to learn more about new payment policies for providers, listen to Premier’s recent webinar. Also, feel free to contact me with questions and to find out how to get involved with QUEST 2020.

Author information

Merrie Wallace

Merrie Wallace

I’m a quality improvement expert from Atlanta, Georgia, who travels the nation working with health systems to improve their quality and PI initiatives. When I’m not working, you’ll find me boating or watching UGA football games. Connect with me on LinkedIn.


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