A new Health Affairs study analyzed the first year of Medicare’s Physician Value-Based Payment Modifier program, whether physician practices were successful and which types of practices performed well on quality and cost metrics.
The study of CMS’ largest ambulatory care pay-for-performance program found that of the more than 600 practices that reported performance data, the practices that choose quality tiering and those with high EHR usage saw better performance on quality and costs compared to other practices. The researchers also found that practices with a primary care focus experienced better quality than other practices, but had similar costs.
The researchers also found that nearly one-third of the 1,010 practices in the first year failed to report performance data and received a 1% reporting-based penalty. The program's penalty in the program has since increased to 4%, which makes reporting the required data even more critical.
The practices that didn’t report data were usually smaller. They also had higher proportions of dually eligible beneficiaries and beneficiaries of racial and ethnic minority groups. The researchers said the results, as well as findings in other studies, point to the fact that providers who care for large disadvantaged populations might not benefit as much from a value-based payment program like MIPS.
“The provision of technical support to practices that serve vulnerable populations may be an important area for policymakers to consider under this program and its successor, the Merit-based Incentive Payment System, to ensure that such programs do not inadvertently widen existing disparities in care,” the researchers wrote.
Practices that didn’t register and report data also had lower levels of meeting Meaningful Use Stage 1 measures, according to the report. “These findings suggest that it may be important for Medicare to focus technical assistance efforts and electronic infrastructure support on smaller practices and those without functional EHRs,” the authors wrote.
The Health Affairs report said lessons from the study can be applied to MIPS despite differences between the two systems. “These findings may have implications for policy efforts to increase participation as well as for quality improvement efforts in the ambulatory care setting, particularly as the nation’s physicians prepare for a transition to the Value Modifier program’s closely related successor, the Merit-based Incentive Payment System.”