• A Guide to Easing into Value-based Payment

    There are many reasons family physician who have been successful with value-based care and payment recommend trying it. If you’re interested in getting started, these initial steps—with advice from peers—can set you on the right path:

    Three steps for getting started

    Step 1. Optimize Fee-for-Service

    Take advantage of fee-for-service billing codes that reward preventive and coordination services. For example, the Annual Wellness Visit is an ideal way to generate revenue and build skills that will help you succeed in value-based payment.

    How To Optimize Fee-for-Service

    ✔️ Pick a service area to focus on. The Medicare annual wellness visit (AWV) offers a rewarding springboard for preparing for value-based payment, and there are AAFP resources to help you.

    ✔️ Understand the components and requirements of the AWV by reviewing the Medicare Learning Network Medicare Wellness Visits Education Tool.

    ✔️ Make a list of patients who have multiple chronic conditions or patients you haven’t seen recently. This can be an informal running list you build with your care team. Check whether a patient is eligible for an AWV (i.e., they haven’t already received one). Learn more about checking eligibility by reviewing a CMS fact sheet on Medicare eligibility.

    ✔️ Start calling patients on this list with Medicare to schedule an AWV. As they schedule visits, have the team explain the benefits and purpose of the AWV.

    Family physician perspective

    Why Optimizing Fee-for-Service Matters

    “I’m really getting a lot more out of these annual wellness visits now, with the extra time I have, and learning more from patients like what their day-to-day is like, what their struggles are. I learn about the things that are potentially going to lead them to the hospital. [...] That has led to better care and lower costs. I’m able to intervene earlier upstream.”—Employed physician

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    Member Tip

    “Around the annual wellness visit, we have navigators and nurses contact a patient ahead of time and go through all of the required elements of that visit and get all the information we can when they’re at home in a comfortable space with their medications available, maybe with family to help them. On average, a nurse is spending 20 to 30 minutes with the patient. And then when they get to the office, I address any of the follow-up that might come out of that annual wellness visit from all the required elements. Every year we step up the number of wellness visits we’re capable of completing, and we’re able to reach a lot more people because we’re able to do a lot of the work on their time, in their environment. So it’s really bringing the care, the best care, to the best place at the right time.”—Employed physician

    Step 2. Empower Your Team

    The team element of value-based care is a reason family physicians, and their care teams, find value-based payment creates a better way to work.

    The AWV is an opportunity to explore additional roles for your existing care team. Many of the AWV’s components can be performed by non-physician care team members, including medical assistants (MAs), under the direct supervision of a physician or other qualified health care professional. Include all members of the care team as you develop your workflow to create a sense of collective ownership.

    How to advance a team with the AWV

    ✔️ Have your MA or other team member send the patient a health risk assessment a day or two before their visit. The patient can load the information into the electronic health record (EHR) through your patient portal, or they can bring it to their appointment and staff can enter it into their record as they room the patient.

    ✔️ Staff can also collect and enter other components of the AWV, such as:

    • Current vitals
    • Medical and family history
    • Pull records of previous screenings (e.g., when the patient had their last colorectal cancer screening).
    • List of current health care professionals and suppliers

    ✔️If already using team-based care, move toward advanced team-based care.

    Family physician perspective

    Why Empowering Your Team Matters

    “We were able to start looking for the things that were going to be important to help take care of our patient population. That was a big, big thing, and we had willing spirits.”—Independent practice

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    Member Tip

    “One of our medical assistants actually became our chronic care manager. It was an easy transition because she had been an MA with us for a while, so she already knew the patients. A lot of people think a care manager has to be an RN, LPN, or a social worker. But I think one of your best MAs who is really good with patients is as good a care manager as any. Workflows made our lives better, they let us shift the culture from ‘We’ve got to deal with what hits us today’ to ‘How can we see a little bit farther into the future? Can we start planning for every patient to have an annual visit at which we talk about their preventive health?’ And that’s the focus. It was a cultural shift for people. We developed workflows that involved somebody who’s been in the emergency room. We call them. We find out if they’re OK. We find out if they picked up their prescriptions, because otherwise they’re going to wind up back in the emergency room again.”—Independent practice

    Step 3. Improve Diagnosis Coding to Reflect Patient Acuity

    By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured, helping you get paid sustainably for the work you’re already doing.

    How to Improve Diagnosis Coding

    ✔️ Educate your entire team on the importance of accurate diagnosis coding. Include members from both the front office and clinical team so that everyone understands what the team is trying to accomplish and the role they play.

    ✔️ Incorporate a team-based approach. Only physicians and other qualified clinicians can make a diagnosis, but everyone on the care team can help ensure each diagnosis is documented appropriately. For example, staff can flag for the physician when the patient is in for their first visit of the year as a reminder to capture diagnoses for the year.

    ✔️ A patient’s risk score resets every year. Use the annual wellness visit as an opportunity to document all relevant diagnoses for the year. Record all diagnoses to the highest level of specificity.

    Family physician perspective

    Why Improving Diagnosis Coding Matters

    “From the very first month that we saw the codes being submitted and accepted and paid, we realized that this was care we had been delivering without reimbursement prior to this.”—Rural practice

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    Member Tip

    “We have a process in the clinic called ‘every patient, every time.’ This means that if a patient is coming in for any reason—their AWV, allergy shot, URI—we check to see if they’re due for any preventive care or have any diagnoses that need to be addressed. It doesn’t always work that we can address them at that visit, but we try our best and then make a note for the next visit. This keeps us on top of managing our patients’ diagnoses for risk-adjustment purposes and provides high-quality preventive care that improves patient outcomes.”—Rural practice

    Related Resources

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