Participants in urological surgery collaborative get additional reimbursement opportunity

Value Partnerships continues to identify new and innovative models to reward physicians for improving the quality of care for our members and all Michigan residents. The most recent example of the program’s ongoing efforts is the new value-based reimbursement project for urologists participating in the Michigan Urology Surgery Improvement Collaborative Quality Initiative, part of Value Partnerships’ Physician Group Incentive Program.

The project combines Blue Cross Blue Shield of Michigan claims data with robust clinical data from the MUSIC CQI registry to identify specific quality targets for our Blue Cross Commercial PPO members who are treated by MUSIC urologists. Blue Cross and MUSIC Coordinating Center leadership collaborated to develop a set of quality measures and performance goals for prostate biopsy-related infections and imaging for patients who’ve been diagnosed with prostate cancer. The goals are to achieve a rate of 26.6 percent or lower for imaging and 6.6 percent or lower for infection.

Additional value-based reimbursement
MUSIC participants have the potential to achieve an additional 3 percent VBR, starting March 1, 2017, for collectively meeting or exceeding specific quality targets. This is in addition to their opportunity to receive 105 percent or 110 percent of the Standard Fee Schedule for performance on population-level measures of cost and quality.

The VBR fee schedule for urologists is applied only to commercial PPO claims for most procedure codes typically billed by urologists.

The two tables below show how the MUSIC VBR will be applied and define the measurement and reimbursement period.

To receive the MUSIC VBR, urologists must fully participate in the collaborative. Participation includes contribution of data to the MUSIC registry.

For more information

• For more details on the value-based reimbursement criteria, see the following two April Record articles:
• Here's what you need to know about participating in Value Partnerships quality programs
• We’re making some changes to the Value-Based Reimbursement Fee Schedule, effective July 1, 2016
• For more information on MUSIC, go to musicurology.com.
  
  
• If you have questions about the information in this article, email Marc Cohen of Value Partnerships at CQIprograms@bcbsm.com.