Value-based care

New APM Committee Accepting Nominations - 05/22/2024

Recognizing the fast-moving shift to value-based care and the need for physician guidance in that transition, the TMA House of Delegates approved a new standing Committee on Alternative Payment Models (APMs) at TexMed 2024. TMA leaders are in the process of appointing participants to the nine-member body with regional representation of varying practice sizes, types, and specialties. Read more.

CMS Finalizes 2025 Medicare Advantage Payment Rates - 04/16/2024

Despite a 0.16% reduction in base pay rate, Medicare Advantage plans are projected to see a 3.7% growth in revenue in 2025 thanks to a rising average patient risk score.

CMS to Debut Primary Care Payment Model - 04/10/2024

In an effort to address financial barriers to accountable care organizations’ provision of primary care services, Medicare will test a new value-based payment model for approximately 130 starting in 2025 and running through 2029.

Medicare Advantage – and Disadvantage: Program Enrollment Grows Amid Physician Concerns - 04/03/2024

Despite its growing popularity among Medicare patients, Medicare Advantage is divisive among physicians.

Middle Ground: Medicare Offers Options Amid Shift to Value-Based Care - 03/05/2024

Physicians are divided on the issue of value-based care, but, with Medicare forging ahead, the Texas Medical Association is focused on monitoring the development of alternative payment models, educating members about their options, and advocating for physician protections.

Survey: APM Participation Grows, But Fee-For-Service Still Dominates - 01/24/2024

Physicians increasingly report participating in an accountable care organization or other alternative payment model, but fee-for-service payments still make up the bulk of practice revenue, continuing a yearslong trend.

Report Aims to Catalyze Texas Medicaid’s Shift to Value-Based Care - 11/02/2023

A new report aims to accelerate Texas Medicaid’s transition from a fee-for-service payment model to a value-based one, a shift that has been underway for 25 years.

Driving the Quality Train: TMA Physicians Lead the Way, From Measures to Standardization - 07/10/2023

In a proactive effort to resolve physician complaints, TMA and its members are deeply involved in quality issues, from participating in the development of new measures to pushing payers for standardized quality programs and supporting physicians who are curious about value-based care.

A Shelter From the Practice Viability Storm: TMA Braces Physicians Amid Economic Headwinds - 05/31/2023

TMA is here to help all practices – regardless of setting or payment model – thrive, remaining steady in its advocacy at the state and federal levels to protect physician autonomy and to defend against the corporate practice of medicine.

Learning Through a Value Lens: Texas Medical Students Learn Value-Based Care Tenets - 04/30/2023

The national Students and Trainees Advocating for Resource Stewardship (STARS) program seeks to catalyze physicians' uptake of value-based care, starting with medical students, whom it anticipates will have long, impactful careers.

Advanced APM Incentive Payments Extended Through 2023 Performance Year - 03/02/2023

Physicians who participate in an advanced alternative payment model this year will remain eligible for incentive payments – albeit smaller ones – that were initially slated to expire in 2022.

Medicare Bundled-Payment Model Could Expand Access to Value-Based Specialty Care - 01/26/2023

Medicare’s recent extension of a bundled payment model marks a rare opportunity for more specialists to participate in value-based care and could pave the way for better coordination with primary care.

New TMA Task Force on Alternative Payment Models Charts a Path Toward Value-Based Care - 01/26/2023

The shift from fee-for-service to value-based care is underway, with public and private payers introducing myriad new payment models in recent years. But many physicians find the variety of plans overwhelming, and the investments necessary to support them challenging.

Holding Their Own: Texas ACOs Contribute to Billions in Savings in Medicare Program - 11/01/2022

For the fifth straight year, the Medicare Shared Savings Program (MSSP), through its work with accountable care organizations (ACOs), generated significant savings and high-quality results, with Texas entities once again contributing to that success.

What's New in Value-Based Care - 09/23/2022

Once dubbed unicorns, value-based care (VBC) models that eschew fee-for-service payment in favor of rewarding quality have materialized; the Texas Medical Association aims to be on the crest of this wave with the formation of its new Task Force on Alternative Payment Models.

Under Construction: Alternative Payment Models Pose Challenges for Specialists - 09/12/2022

Many physician specialists face a conundrum: Without a dedicated alternative payment model in place for their specialty, there's little incentive for them to break away from the fee-for-service paradigm.

Texas ACOs Contribute to $1.6 Billion in Savings in Medicare Shared Savings Program - 09/09/2022

For the fifth straight year, the Medicare Shared Savings Program (MSSP), through its work with accountable care organizations, generated significant savings and high-quality results, with Texas entities once again contributing to that success.

The Only Alternative: Medicaid Practices May Not Be Viable Without Value-Based Care - 07/29/2022

For years, the Texas Medical Association has pushed for a significant Medicaid physician pay bump every year that the Texas Legislature meets, without success. As long as that streak continues, physicians looking to make Medicaid more worthwhile for their bottom line have to find another way. Value-based systems – and the alternative payment models that drive them – have been the path Medicaid managed care organizations and practitioners have been methodically walking in recent years.

Value-Based Care for All: Practices of All Sizes Can Make the Switch - 07/29/2022

Moving away from fee-for-service requires taking on risk as well as hiring staff, launching new programs, and investing in data analysis, but practices of all stripes have made the switch successfully.

The Customer Is Always Right? Patient-Reported Outcome Measures Have Fans and Detractors - 01/26/2021

For too long, some doctors say measures of a physician’s quality of care have been about process: the average length of a patient stay, for example, or a patient’s readmission rate. The bottom line is results, and that’s why a shift to patient-reported outcome (PRO) measures is necessary. However, even proponents of PRO measures note that collecting the information from patients for those metrics places burdens on physicians, and some remain skeptical of bonuses and penalties tied to a measure that derives from a subjective factor: what patients think.

Troubling Trend: Texas’ 2018 QPP Data Contains More Bad Signs - 01/05/2021

As the Centers for Medicare & Medicaid Services continues to churn out glowing data annually on its Quality Payment Program (QPP), a full picture of the program’s impact eludes the agency’s reporting. According to the Texas Medical Association’s analysis of state-level data in the 2018 QPP Experience Report, it’s clear that small practices continue to feel most of the program’s punitive pressures.

Rewarding Results: Texas Medicare ACOs Perform Promisingly - 11/30/2020

For the Medicare Shared Savings Program (MSSP) and many of the accountable care organizations (ACOs) that participated in it, 2019 was billed as a transition year. But data released by the Centers for Medicare & Medicaid Services (CMS) in September show Texas ACOs fared quite well last year – and a number of Texas physicians and ACO officials say the savings generated are worth the gruntwork that MSSP requires.

Quality Care Pilot Takes Flight - 09/03/2019

How one children's clinic uses a targeted program to dramatically improve care, lower costs.