Tiny percentage of physician groups earned CMS value-based care bonus

Accreditation Insider, March 15, 2016

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It’s the second year for CMS’s value-based payment modifier (VBM) program, a part of the Affordable Care Act using Medicare reimbursements to encourage high-quality and cost-effective care. However, the number of physician groups rewarded for their scores on the Physician Quality Reporting System (PQRS) was under a tenth of a fraction of 1%. As for punishment, a physician group was nearly 200 times more likely to be sanctioned for not submitting their quality data than actually having a poor PQRS score.

Only 128 out of the 13,813 physician groups eligible for the program received a 16% or 32% increase to Medicare reimbursements. That represents only 0.009% of medical groups, or 4,300 physicians, to benefit from the program. The number punished under the program was even smaller, with 59 physician groups (0.004%) receiving a pay decrease of 1% to 2% because their PQRS scores weren’t high enough.

The large bulk (59%) of physician groups saw no change to their reimbursement rates, while 39% received a 2% pay cut for failing to submit their PQRS data.

“These results show that getting a reimbursement increase is akin to winning the lottery,” Anders Gilberg, senior vice president for the Medical Group Management Association, said in a Modern Healthcare interview. “This just isn't a meaningful system.”

Last year, the VBM only applied to group practices with more than 100 eligible professionals, and this year it expanded to include practices with 10 or more professionals. Next year, the program will be applied to all group practices in the U.S. with anyone not submitting PQRS data being penalized.

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