Local Physicians Agree to New Reimbursement System with Excellus, RGHS

Jun 13, 2013

Credit www.thinkprogress.org

A new payment system intended to cut health care costs and improve patient care has been put in place following an agreement between local physicians, Rochester General Health System (RGHS), and Excellus BlueCross BlueShield.

Physician members of the Greater Rochester Independent Practice Association (GRIPA) have agreed to a five-year contract that adds financial incentives for GRIPA physicians based on the health of their patient population.

The agreement would help move the industry from a "fee-for-service" model with compensation that is based on clinical performance and patient outcomes.  "It really realigns the economic incentives to reward our physicians and our health system for  improving the health of more than 110,000 members of our community and at the same time, moderate the rate of increase of health care spending," said Mark Clement, president CEO of RGHS.

The new reimbursement model has been in place since January, but was announced today after it was formalized.  Clement said the new payment system is a reflection of a number of changes that will occur as a result of the Affordable Care Act.  "It's going to shift where care is provided from more expensive settings to less expensive settings. It's going to push down reimbursement rates. Our fee for service rates are going to be reduced and have been reduced over time. It's really intended to improve and expand access (to health care)."