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Value-based programs may hurt providers that serve a lot of poor people

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A new JAMA report that reviewed the first year of the Medicare Physician Value-Based Payment Modifier (PVBM) Program  found that providers who served “more socially high-risk patients {who are mostly lower socio-economic class} had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.” This led to fewer bonuses and more penalties for high-risk practices.

The authors said  that value-based payment programs may financially harm practices that “disproportionately serve high-risk patients.”

CMS created the PVBM to measure the quality and cost of care provided to Medicare beneficiaries. Payments are based on providers’ performance on quality and cost measures.

Healthcare Dive commented:

“The JAMA study’s finding that more medically high-risk patients had lower quality and higher costs is eye-opening. Those patients are usually the most costly and payment models will need to figure out ways to reduce those costs while not penalizing physicians if value-based programs are successful. A payment model that only lowers costs and improves care to healthy people won’t move the needle.

“Even worse, if physicians are penalized, what incentive do doctors have to care for the sickest Medicare patients?

“The JAMA report will likely not quell physician fears about how value-based programs may lead to lower Medicare payments. It also won’t satisfy individuals concerned that changes to the healthcare system may harm the most vulnerable, which is always a worry when there are major healthcare changes.”

“One key finding about value-based care so far has been that experience in the model plays an important role in whether a provider has success. Organizations with the most success under value-based programs have often spent years creating clinically integrated networks, James Landman, director of healthcare finance policy at the Healthcare Financial Management Association, recently told Healthcare Dive.

“If you look at the data for the Medicare Shared Savings Program, which is the biggest of the ACO {Accountable Care Organization} programs under CMS, there is a correlation between time spent in the program and the ability to generate savings,” Landman said.”

To read the JAMA report, please hit this link.

To read the Healthcare Dive analysis, please hit this link.

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