Health policy expert: Delays possible in QPP, audits

by Roy Edroso on Dec 27, 2016

For the first Part B News issue of the year, several experts shared their 2017 health care predictions. Here are more prognostications from Kristen Valdes, founder and CEO of the Baltimore health IT company b.well.

Possible quality payment program (QPP) delay

With the threat of losing more physicians, especially in Medicare, I believe congress and the president will need to take a hard look at delaying payment adjustments until more time and more money have been made available to meet the quality requirements. The issue is in the implementation of these programs technically, not that most providers are not on board with the goal of the programs. It would go a long way toward continuing to move the ball forward if there were less pressure on time.

More payer-provider collaboration

Payers will continue to move toward pay for value, which will increase the need for payers and providers to share data and support each other with case management, disease management and utilization management. This trend will continue and will accelerate in 2017.

M.D.s still prefer contract employment

Until the cost of liability insurance comes down, providers will continue to move toward employment contracts. As the move to pay for value continues, individual providers without advanced analytics systems that integrate with payers and other provider data stores will have a harder time making an adequate salary. Employment through a larger practice or system protects physicians and provides stable income. 

More audits -- but only after a few years

A presidential change also means a shift change at the agencies responsible for audits in health care. That means a slow down as the transition occurs, and with new leadership comes new programs, new vendors and re-competed contracts. I believe there will be a move toward being more aggressive on audits and fines -- but it won’t happen for a couple of years.

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