The ultimate in Medicare pay-for-performance programs reached physicians last year when the value-based purchasing program kicked in for groups of over 100 doctors. CMS released results for 2014, which affect payments in 2016, this time for groups of ten or more doctors. (CMS Release) The program rewards physicians based on their quality measure scores, patient satisfaction and economic efficiency. 13,813 physician groups participated in 2014, but only 128 groups, with 4300 doctors, will see pay increases, some of 16% and some of 32%. On the other hand, 5418 groups, with 131,084 doctors will get a 2% pay cut because they didn’t even submit data. You have to suspect that most of these groups don’t do a lot of Medicare business, so it wasn’t worth the effort for them to avoid the pay cut. And 59 groups with 10,000 physicians will get a 1% or 2% pay cut because their scores were low. Most groups, 8208 representing 314,546 doctors, will see no change in reimbursements because their scores were middle-of-the road. Interestingly, groups of between 10 and 99 doctors did at least as well as groups with over 100 physicians, suggesting that at some point scale and more resources aren’t improving either quality or efficiency.
CMS determines payment effects by a quality/cost tiering method, with low-cost, average cost, and high cost on one dimension and low quality, average quality and high quality on the other. So how many high quality, low-cost groups were there? Exactly none, so the message here appears to be, higher quality does cost something. There were more average cost, high quality ones–35 who will get 16% increase and 20 who will get a 32% one. Average quality and low-cost gets the 35 groups in this bucket a 16% increase as well, and 38 more got a 32% jump in payments. Low quality didn’t affect the payments of the 6 groups that were also low-cost. I guess the message is we don’t care if you deliver lousy care as long as you don’t cost us too much. The value-based purchasing program is being phased in and will apply to all doctors participating in Medicare next year. Based on results so far, it will be a non-event for most of them, other than the significant cost complying with program’s requirements imposes on practices. It is very unclear that the program does anything to improve patient outcomes. And it would be useful to see the analysis give the actual number of beneficiaries covered by practices in the various quality/cost tiers.