Service Line and Specialty-Specific Clinical Integration Programs: A Novel Model for Hospital-Physician Alignment

• January 23, 2019

All providers, regardless of specialty, are now subject to the Medicare Access and CHIP Reauthorization Act (MACRA), which puts them at significant risk for payment adjustments based on their performance across four categories of quality, cost, and other measures. Furthermore, bundled payments are being rolled out by many payers, especially by the Centers for Medicare and Medicaid Services (CMS). Several hospital service lines, particularly cardiology and orthopedic, seem to be affected most directly by CMS’s move toward value-based reimbursements (VBRs).

Any service line restructuring, particularly cardiology or orthopedic service lines, should consider these new payment models and how these areas of operations might best operate in a move to a VBR environment. This paper describes how the development of a service line-specific clinical integration program (SSCIP) can serve as a viable answer to this query. Further, it will address how to go about setting up such a model of care delivery.