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Value-Based Payment Modifier Not Tied to Practice Performance

Performance differences between practices narrowed after adjustment for patient characteristics


TUESDAY, Nov. 28, 2017 (HealthDay News) -- The Value-Based Payment Modifier (VM) is not associated with performance differences between practices serving higher-risk and lower-risk patients, according to a study published online Nov. 28 in the Annals of Internal Medicine.

Eric T. Roberts, Ph.D., from the University of Pittsburgh, and colleagues estimated the correlation between VM exposure and performance on quality and spending measures and examined the impact of adjustment for additional patient characteristics on performance in practices serving higher- and lower-risk patients. The authors estimated differences in practice performance associated with exposure of practices with 100 or more clinicians to full VM incentives (bonuses and penalties), and exposure of practices with 10 or more clinicians to partial VM incentives (bonuses only) using 2014 Medicare claims. The analyses were repeated with 2015 claims.

The researchers found that at the threshold of 10 or more or 100 or more clinicians there were no statistically significant discontinuities in the relationship between practice size and performance on quality or spending measures in either year. Performance differences were narrowed by 9.2 to 67.9 percent between practices in the highest and lowest quartile of Medicaid patients and Hierarchical Condition Category scores, after adjustment for additional patient characteristics.

"Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare's pay-for-performance programs to exacerbate health care disparities," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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