We’re announcing 2020 updates for value-based reimbursement for specialists

Effective March 1, 2020, the Physician Group Incentive Program is:

• Introducing a new specialist value-based reimbursement opportunity through a pilot program
• Implementing a change to the specialist VBR methodology

New VBR opportunity
In 2020, PGIP is starting a pilot program to encourage specialists to adopt a team-based care approach, supported by care managers. We’ll facilitate this team-based care by using existing and upcoming Health Information Exchange capabilities in the PGIP physician organizations.

To be considered for this pilot, physician organizations must submit attestations on behalf of the participating specialists to PGIP by Jan. 10, 2020. PGIP physician organizations that meet program requirements will reach out to select specialists in their PO to assess interest and eligibility, and to obtain the necessary attestations.

In 2020, cardiologists, endocrinologists, nephrologists, oncologists and pulmonologists in PGIP can be included in this pilot.

Specialists participating in the pilot will be eligible to receive VBR (at 105% of the standard fee schedule) if they meet all the requirements of the pilot.

Updated psychologists VBR methodology
The methodology for determining the number of fully licensed psychologists eligible to be reimbursed in accordance with the VBR fee schedule is changing slightly next year. Effective March 1, 2020, four-fifths of the nominated, ranked psychologist practices in PGIP (versus two-thirds) will be eligible to receive VBR.

If you’re a member of PGIP and have questions, reach out to your PGIP physician organization.