So far, few provider practices have benefited from the CMS' value-based payment modifier program, according to agency data (PDF).
The payment initiative, outlined in the Affordable Care Act, is meant to encourage physicians and practice groups to provide high quality and cost-effective care. Eventually, the value modifier will apply to all healthcare practitioners, but this year it was voluntary and applied only to groups of 100 or more eligible professionals.
As many as 1,278 groups fit this category, but only 127 groups elected to be evaluated under the modifier. Of those, 106 had sufficient data to calculate cost and quality information, according to the CMS. Ultimately, 81 practices received no additional adjustment, 14 practices qualified for an upward adjustment, and 11 practices received a downward adjustment.
Physician groups getting increases had, on average, better hospital readmissions rates, at 14.3 per 100 admissions compared with the national benchmark of 16.4. These groups also on average had lower hospital admissions rates for acute and chronic ambulatory care sensitive conditions, according to the CMS.
“When it comes to improving the way providers are paid, we want to reward value and high-quality care, rather than volume,” Sean Cavanaugh, deputy administrator and director at the CMS, and Dr. Patrick Conway, its chief medical officer, said in statement on the results. “The value modifier reinforces our emphasis on quality, value and shared accountability, and recognizes and rewards those physician groups and physicians who meet those goals.”
Beginning in 2016, the modifier will apply to groups with at least 10 or more eligible professionals, and it won't be optional. In 2017, it will apply to all groups and to solo practitioners who are physicians. And in 2018, the CMS will apply it to non-physician eligible professionals as well.
“Physicians and health systems should take note of this new reimbursement paradigm,” Laura Little, an attorney with Arnall Golden Gregory, said in an analysis of the findings. “Although the CY2015 results show limited financial impact for most physicians, the program, at its core, is a cost containment system. Consequently, physicians may face larger negative adjustments in the future.”
