Unbiased Analysis of Today's Healthcare Issues
While CMS has a target of getting 100% of Medicare beneficiaries into value-based payment (VBP) programs–such as accountable care organizations–by the end of the decade, implementing VBP in practice will be challenging. An editorial by Navathe et al. (2024) in Health Affairs provides some key considerations. Providers forego certain revenue for uncertain ‘bonus’ payments. “One…
Public reporting of hospital quality of care could improve the care patients receive through at least two pathways. First, patients (or their physicians) could send patients to higher quality hospitals (i.e., the selection pathway). Alternatively, hospitals themselves could have behavioral responses to the metrics and may improve quality of care in response to public reporting…
Alternative payment models (APM) are the new trend of the past few decades. High quality, efficient providers should be paid more; low-quality, less efficient providers should be paid less. These APM reimbursement arrangements, however, are typically paid at the health system level and it is unclear whether these incentives trickle down to individual physicians. A…
The Government Accountability Office (GAO) last week published a report evaluating the Merit-based Incentive Payment System (MIPS). MIPS is an approach for CMS to pay physicians caring for Medicare beneficiaries based not just on volume but on value. MIPS evaluates provider value along four dimensions: (1) quality, (2) improvement activities, (3) promoting interoperability, and (4)…
Medicare’s Merit-based Incentive Payment System (MIPS) aims to link physician quality of care to their reimbursement. At first glance, paying more to high quality physicians seems like a great idea. However, a paper by Liao et al. (2018) surveys physicians from a large national sample maintained by the American College of Physicians (ACP). They find…
CMS has focused in recent years on payment reform–especially alternative payment models–in Medicare’s fee-for-service (FFS) reimbursement system, but much less has been paid to beneficiaries enrolled in Medicare’s managed care program (i.e., Medicare Advantage). Currently, however, more than 1 in 3 beneficiaries are enrolled in an Medicare Advantage plan, and by 2028 that number could…
Are physicians ready for value-based payment? That is the question a recent paper by Markovitz et al. (2017) attempts to answer. This question is not hypothetical as the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) requires physicians to choose between the current fee-for-service structure under the Merit-Based Incentive Payment System (MIPS) or…
Please check out my latest publication in Value in Health titled “Value-Based Payments and Incentives to Improve Care: A Case Study of Patients with Type 2 Diabetes in Medicare Advantage“. This work is based on research conducted with my co-authors Jesse Sussell, Kata Bognar, Taylor T. Schwartz, John J. Sheehan, Wade Aubry, and Dennis Scanlon,…
Value-based payment is the latest hot topic. One question remains, however, does it work? Does paying for quality improve quality. A study by Zuckerman et al. (2016) finds that the hospital readmissions reduction program (HRRP) did appear to reduce re-hospitalization rates among the targeted conditions. What about the hospital value-based purchasing program (HVBP). Beginning in…
Value-based payment for providers is often predicated on being able to measure physician quality with a single composite measures. For instance, Medicare’ s Value-Based Payment Modifier (Value Modifier) combines a variety of individual quality metrics across domains to create a single quality score. Payment to physicians is adjusted based on a combination of physician quality…