"We were ahead of the ACO curve by 2 or 3 years for most people, but again for our size, it's kind of like, let's invent this lifeboat before we need it," Boyce says. "We just said let's evolve it ourselves quicker to this new payment model."
Mosaic set the stage in 2012 when it entered its first accountable care organization arrangement with CMS. Modifying its Cerner EHR software, Mosaic was able to create a summary page "that basically shows all of the quality measures we've got for a patient, and which ones are overdue, and which ones are due next or when they were done," Boyce says. The system has been so effective, it is becoming difficult for him to find records of any patients who have significant gaps in care, he says.
Mosaic also minimized some of the transition pain by moving into a new market 55 miles south of St. Joseph. "By opening our clinics in the Kansas City area, as an outpatient move, we wouldn't hurt our inpatient services as much," Boyce says.
Then there are the systems for which fee-for-service is still the norm, and the path ahead is steepest of all.
At Spartanburg Regional Healthcare System, which consists of three hospitals and 23 primary care practices, "I still live and breathe in fee-for-service," says E.G. "Nick" Ulmer Jr., MD, CPC, vice president of clinical integration and medical director of case management. "We're really now looking at quality not only on the inpatient side, but we have a medical group here of 300-plus physicians that are employed."
Given its experience with PQRS and meaningful use, "it's become very complex in the last couple of years, and even more so in the last year as we start to educate physicians on MACRA, MIPS, and alternate payment models," Ulmer says.
Spartanburg does have some contracts "where there is a shared-savings type of opportunity, which is not the Medicare Shared Savings, but it's a contract where there are quality metrics tied to our revenues," Ulmer says. "There are quality metrics in some contracts where we get bonuses, but we're still fee-for-service underneath those. It's not that we're given a dollar to manage the care. It's that we're getting paid a negotiated fee-for-service rate with opportunities to get bonuses that are linked to cost and quality and things along the lines of safety, like readmissions and ED utilization."
Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.