Investments in health IT and financial risk-sharing are two big obstacles standing in the way of many small practices getting on board with value-based payment models, states
a new report from the Government Accountability Office (GAO).
Practices that make an investment in electronic health record (EHR) technology that's capable of meeting strict value-based requirements -- such as capturing population health data and being interoperable with other provider groups -- can wait up to two years or more to see a single dollar in return, notes the report,
Participation Challenges and Available Assistance for Small and Rural Practices.
"Small and rural practices need financial resources to make initial investments, such as those to make EHR systems interoperable, and need financial reserves or reinsurance to participate in models that have downside risk. Recouping investments may take years," states the report, which combines feedback from 38 small practices and physician advocacy organizations.
Other hurdles, such as data reporting, also provide a clear challenge to smaller groups. "Many small practices lack experience with value-based payment models and their requirements, such as performance reporting, and rural practices may face unique challenges when participating in a value-based payment model," adds the report.
The GAO identified
five elements that are causing problems among small practices -- they span financial resources and risk management; health IT and data; population health management care delivery; quality and efficiency performance measurement and reporting; and effects of model participation and managing compliance with requirements.
Of course, many small practices can automatically opt out of the merit-based incentive payment system (MIPS) in 2017 because of the
low-volume threshold that CMS finalized this year -- CMS expects 57% of practices to avoid MIPS in 2017. If you're unsure of your status, here's
a three-question guide to tell you if you're excluded.
As part of the quality payment program (QPP), CMS is making available
nearly $800 million in technical assistance and transition aid. The GAO report suggests more help may be necessary.