posted on May 07, 2015 04:34
Beginning in February 2016, anesthesiologists will be participating in Blue Cross Blue Shield of Michigan's (BCBSM) Physician Group Incentive Program (PGIP) and become eligible to receive fee uplifts. The MSA Practice Management Committee met last week with BCBSM's representatives to learn about anesthesiologists' upcoming participation in this program. The below is an effort to share the highlights with you and, most importantly, to notify you of the need to be registered and nominated by your Physician Organization (PO) by June 28th, 2015, in order to be eligible for participation beginning in February of 2016.
Background on PGIP
Blue Cross Blue Shield of Michigan's (BCBSM) Physician Group Incentive Program (PGIP) continues to grow and to evolve. PGIP initially focused predominantly on building primary care infrastructure; however, over the past few years, there has been increased emphasis on bringing specialists into the PGIP mix.
In 2014, the number of specialties eligible for fee uplifts increased from 7 to 24. BCBSM reports that in 2015 all specialties except for anesthesiology will be eligible for fee uplifts in PGIP. The inclusion of specialists in BCBSM PGIP specialty fee uplifts is intended to help promote the evolution of the Patient-Centered Medical Home (PCMH) to the PCMH "neighborhood" (PCMH-N) in which specialists are actively engaged in transformation efforts including enhanced interaction and coordination with their respective PCMH partners.
To be considered for the fee uplift, a specialty practice must be nominated by their Physician Organization (PO) or by a PO in which the majority of their patients are attributed. Nomination does not guarantee that a practice will receive an uplift. Determinations are made annually based on one or more metrics of quality, utilization, efficiency, and cost performance. Most measures look at population-level performance versus practice-level performance. Specialists typically have to be a member of PGIP for at least one year before they can be nominated and nominations will occur earlier than in prior years. Fee uplifts are effective beginning in February of each year and are applied to PPO traditional commercial claims.
In 2015, the top half of ranked, fully nominated practices received either a 10% uplift (top quartile) or a 5% uplift (second quartile). There will be no uplift for the remainder of the nominated practices. The same payment formula will be used in 2016.
|Click here to for a larger view of the flow chart.
Specialist Fee Uplifts for Anesthesiologists for 2016
To be eligible for the 2016 uplift, anesthesiologists must be signed up with a PGIP PO and entered into the BCBSM PGIP data tool by June 28, 2015. A list of PGIP POs can be found at http://www.bcbsm.com/content/dam/public/Providers/Documents/help/faqs/po-list-with-contacts.pdf. Practices must be nominated by their member PO. Nomination is based upon Patient-Centered Medical Home-Neighbor principles. BCBSM will use population-level per member per month cost and population-level quality composite for performance measures. Approximately 50 percent of anesthesiologists nominated will receive an uplift of either 10 or 5 percent.
Fee uplifts are applied only to PPO/Traditional Commercial claims. Fee uplifts currently apply to the RVU-based procedure codes, not to time-based codes. So, beginning February 2016, anesthesiologists will begin to receive fee uplifts for RVU-based procedure codes, such as pain management and conscious sedation. BCBSM is exploring approaches and possible options to extend fee uplifts to the time-based codes.
Additional information on the BCBS PGIP program can be found here:
There will be a continued effort to distribute new information to our membership as it is shared with our society's leadership.
Harry Parr, DO, MBA
Chair, MSA Practice Management Committee