For the second year in a row, few provider practices benefited from the CMS' value-based payment modifier (VBM) program, according to agency data.
In all, 13,813 physician groups were eligible to compete for the pay bump, but only 128 group practices, comprising 4,300 physicians, will see their Medicare reimbursement increase by 16% or 32%, with the higher percentage going to practices with the most high-risk patients, according to agency data released March 7 (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.
The CMS has gradually phased in the VBM program. It only applied to group practices of 100 or more eligible professionals last year, and to groups of 10 or more this year. Next year, it will apply to all physicians and physician groups.
Under the VBM program, physician payments are adjusted up or down based on how they score on quality and cost-effectiveness measures. Providers' raises this year are based on 2014 Physician Quality Reporting System (PQRS) data.
Another 5,418 medical groups and their 131,084 physicians will incur a 2% pay cut for not submitting PQRS data. Finally, 59 groups composed of more than 10,000 physicians, will also see a pay decrease of 1% or 2% this year because their PQRS data didn't score high enough for a bump.
The groups will start seeing the adjustments on their claims within the next six weeks, the CMS said.
The remaining 8,208 U.S. medical groups, which comprise 314,546 physicians, will see their Medicare rates remain the same, since their quality data were neither good nor bad enough to warrant a reimbursement change.
Last year, when VBM evaluation was optional, 127 groups submitted evaluation data. Of those, 106 met the requirements to calculate cost and quality information, according to the CMS. Ultimately, 81 practices received no additional adjustment, and 14 practices qualified for a raise.
The fact that so few practices benefit from VBM could indicate an inherent flaw in the program's methodology, said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.
“These results show that getting a reimbursement increase is akin to winning the lottery,” Gilberg said. “This just isn't a meaningful system.”
For the American Medical Group Association, the results raise more questions than answers, said David Introcaso, senior director for regulatory and public policy with the trade group. He wondered why so many practices failed to submit the minimal PQRS data required for evaluation. He said he hoped the findings will serve as a wake-up call for those organizations.
A CMS spokesperson did not immediately return a request for comment.