More than half of hospitals holding off on value-based care, study says
The majority of U.S. hospitals are still trying to determine how exactly the new landscape of alternative payment models will form and, as such, indicated that they are holding off for now, according to a study published by Peer60.
Indeed, 37 percent of responding hospitals plan to adopt alternative payment models for value-based care, while 5 percent answered that they are not pursuing value-based care. The remaining 58 percent are the holdouts, Peer60 said.
Many hospitals, in the meantime, are buckling down to focus on effective revenue cycle management operations.
Asked to list the most critical components of the their RCM strategies, the hospitals listed collections (72 percent), denial management (69 percent), registration (65 percent), eligibility and benefits (61 percent) as their top concerns. Capabilities such as benchmarking, scheduling and referrals were further down the list.
"One thing is clear: effective RCM operations are absolutely critical to the overall health of every single provider organization in the country," according to Peer60.
This is especially true as the reimbursement landscape undergoes far-reaching and transformative change, of course.
"Bigger hospitals are much more likely to have the resources to pull off a new payment model adoption than smaller hospitals," according to the report. "What we find interesting is the percent of outpatient participants suggesting they will wade out into the murky waters of value-based care, despite the significantly different business models many of the facilities operate under compared to hospitals."
Of those hospitals pursuing value-based arrangements, there was no shortage of models to choose from. Hospitals were embracing bundled payments (34 percent), value-based-purchasing (31 percent), ACOs (31 percent), MACRA (21 percent and 17 percent for MIPS and APMs, respectively), Comprehensive Primary Care and CPC+ (10 percent), partial capitation (7 percent), pay-for-performance (7 percent) and more.
[Also: Health Catalyst: Only 3 percent of hospitals meet CMS target for value-based care]
As they move toward this new world, providers are looking for reliable vendor partners – technology developers and consulting/advisory firms alike – to help them. Among the most highly cited: IBM, with its Truven Health analytics and Phytel subsidiaries (14 percent), Premier (14 percent), the Advisory Board (11 percent), OptumInsight (11 percent), Change Healthcare/Emdeon (7 percent) and Availity (7 percent)
"This year we see a host of additional vendors being cited as helping providers with alternative payment models," according to the report. "In addition, there was a flattening out of responses with no single vendor dominating the landscape as was displayed last year with The Advisory Board Company and to a lesser degree OptumInsight. One thing’s for sure: as APMs continue to take shape, a handful of these vendors stand to gain a significant new source of business.
Peer60 said that 5 percent of responding hospitals offered a flat "no" to value-based models some feared physicians would be paid less thanks to noncompliant patients. Anecdotally, respondents didn't hold back in offering their opinions of the the new state of affairs.
APM outcomes "are determined primarily by patient compliance and it is diabolical to blame doctors for this," said one. "Doctors should be paid on the basis of how much work they do (that is how every other professional is paid!), and not on the basis of patient compliance. Under this new model, physicians will start to cherry pick patients, and the sicker, less compliant patients will have no care.”
Others voiced concerns about metrics and performance measurement used by different payers: Without a standardized approach, they said, quality as measured by national organizations might not accurately reflect localized realities of supply and demand: “Metrics used by payers are not reflective of the true quality of services delivered," said one respondent.
That said, APMs are only a matter of time, according to Peer60. "We see a veritable cornucopia of different options, from large RCM-focused firms such as Change Healthcare (Emdeon) to enterprise entities in the mold of Cerner to 'payviders' like Aetna (ActiveHealth) to hybrid solutions providers along the lines of the Advisory Board Company."
Still, while care providers are undoubtedly feeling the pressure to ensure quality standards and more efficient care coordination, many are still not ready to take the leap to new models.
"It’s not yet possible to pick out the nitty-gritty details of an ideal value-based payment system when so few providers are willing to try it out," according to Peer60. "As long as some providers think it’s actually 'diabolical,' and as long as the government continues to allow providers the choice to adopt or not, it seems likely that small hospitals will stick with the status quo."
The study, "Healthcare Revenue Cycle Management: Trends in Alternative Payment Model Adoption," polled finance executives at hospitals of various sizes. Most respondents were CFOs (41 percent) and VPs of finance, business office managers, COOs and CEOs were also surveyed. Half of respondents were from smaller organizations of 100 beds or fewer; a more modest percentage (19 percent) had 501 beds or more.
Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com
