Value Based Reimbursement

The Shift From Quantity to Quality

CMS (Centers for Medicare and Medicaid Services) is transforming physician payment with the advent of VBR (Value Based Reimbursement), which encourages and rewards physicians for submission of quality data, and by applying risk adjustment payments for complex patient care. P3N provides the infrastructure for private practice physicians to capture and report the necessary data in the most efficient way.

How is P3N Involved?

CMS currently has many projects underway as part of this VBR initiative. P3N is developing tools and services to help our physician network take advantage of these opportunities. The following list highlights currently available VBR programs P3N offers:

  • MACRA/MIPS
  • ACO shared savings
  • Annual Wellness Visit
  • Chronic Care Management
  • Transitional Care Management

Potential Quality Reimbursement in ACO and VBR

100 MEDICARE LIVES
Assume $50,000 MC pay
200 MEDICARE LIVES
Assume $100,000 pay
MACRA/MIPS 4%-9% up/down $2,000-$4,000 $4,000-$8,000
ANNUAL WELLNESS
(plus E/M code+25)
$16,150 $32,300
CHRONIC CARE
MANAGEMENT (50/100 PTS)
$10,500 $21,000
TRANSITION CARE
MANAGEMENT
$5,328 $10,656
ACO ($126/PT) $12,600 $25,200
TOTAL $46,578 $93,156

100 MEDICARE LIVES Assume $50,000 MC pay

MACRA/MIPS 4%-9% up/down
$2,000-$4,000

200 MEDICARE LIVES Assume $100,000 pay

MACRA/MIPS 4%-9% up/down
$4,000-$8,000

100 MEDICARE LIVES Assume $50,000 MC pay

ANNUAL WELLNESS (plus E/M code+25)
$16,150

200 MEDICARE LIVES Assume $100,000 pay

ANNUAL WELLNESS (plus E/M code+25)
$32,300

100 MEDICARE LIVES Assume $50,000 MC pay

CHRONIC CARE MANAGEMENT (50/100 PTS)
$10,500

200 MEDICARE LIVES Assume $100,000 pay

CHRONIC CARE MANAGEMENT (50/100 PTS)
$21,000

100 MEDICARE LIVES Assume $50,000 MC pay

TRANSITION CARE MANAGEMENT
$5,328

200 MEDICARE LIVES Assume $100,000 pay

TRANSITION CARE MANAGEMENT
$10,656

100 MEDICARE LIVES Assume $50,000 MC pay

ACO ($126/PT)
$12,600

200 MEDICARE LIVES Assume $100,000 pay

ACO ($126/PT)
$25,200

100 MEDICARE LIVES Assume $50,000 MC pay

TOTAL
$46,578

200 MEDICARE LIVES Assume $100,000 pay

TOTAL
$93,156