Value-Based Payment for Physicians in Medicare: Small Step or Giant Leap?
Authors: Andrew M. Ryan, Matthew J. Press
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions15 April 2014Value-Based Payment for Physicians in Medicare: Small Step or Giant Leap?Andrew M. Ryan, PhD and Matthew J. Press, MD, MScAndrew M. Ryan, PhDFrom Weill Cornell Medical College, New York, New York.Search for more papers by this author and Matthew J. Press, MD, MScFrom Weill Cornell Medical College, New York, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M13-1715 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In response to extensive evidence of high costs and variable quality of health care, the Patient Protection and Affordable Care Act created the Physician Value-Based Payment Modifier (PVBPM), the first national value-based purchasing program for physicians in fee-for-service Medicare. In 2013, the program required physicians in all practices to report data for the Physician Quality Reporting System—the precursor to the PVBPM—to avoid a payment penalty in 2015. The PVBPM will then use these data to modify Medicare Part B payments for physicians in “large” practices (those with 100 or more eligible professionals) beginning in 2015. Current proposals from the Centers ...References1. Centers for Medicare & Medicaid Services. Medicare program; revisions to payment policies under the physician fee schedule, clinical laboratory fee schedule & other revisions to Part B for CY 2014. Fed Regist. 2013;78:43282-532. Accessed at www.gpo.gov/fdsys/pkg/FR-2013-07-19/pdf/2013-16547.pdf on 3 March 2014. Google Scholar2. Centers for Medicare & Medicaid Services. Medicare program; revisions to payment policies under the physician fee schedule, DME face-to-face encounters, elimination of the requirement for termination of non-random prepayment complex medical review and other revisions to Part B for CY 2013; final rule. Fed Regist. 2012;77:68892-9380. Accessed at www.gpo.gov/fdsys/pkg/FR-2012-11-16/pdf/2012-26900.pdf on 3 March 2014. Google Scholar3. VanLare JM, Blum JD, Conway PH. Linking performance with payment: implementing the Physician Value-Based Payment Modifier. JAMA. 2012;308:2089-90. [PMID: 23198298] CrossrefMedlineGoogle Scholar4. Alexander JA, Maeng D, Casalino LP, Rittenhouse D. Use of care management practices in small- and medium-sized physician groups: do public reporting of physician quality and financial incentives matter? Health Serv Res. 2013;48:376-97. [PMID: 22880957] CrossrefMedlineGoogle Scholar5. Bishop TF, Federman AD, Ross JS. Association between physician quality improvement incentives and ambulatory quality measures. Am J Manag Care. 2012;18:126-34. [PMID: 22554038] MedlineGoogle Scholar6. Centers for Medicare & Medicaid Services. Physician Quality Reporting System (PQRS) overview. 2013. Accessed at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_OverviewFactSheet_2013_08_06.pdf on 3 March 2014. Google Scholar7. Ryan AM, Nallamothu BK, Dimick JB. Medicare's public reporting initiative on hospital quality had modest or no impact on mortality from three key conditions. Health Aff (Millwood). 2012;31:585-92. [PMID: 22392670] CrossrefMedlineGoogle Scholar8. Berenson RA, Ginsburg PB, Kemper N. Unchecked provider clout in California foreshadows challenges to health reform. Health Aff (Millwood). 2010;29:699-705. [PMID: 20185503] CrossrefMedlineGoogle Scholar9. Carey MA. Hill plan would reward doctors for quality. Kaiser Health News. 7 February 2014. Accessed at www.kaiserhealthnews.org/stories/2014/february/06/bipartisan-bill-medicare-sustainable-growth-rate-doc-fix.aspx on 3 March 2014. Google Scholar10. Muhlestein D. Continued growth of public and private accountable care organizations. Health Affairs Blog. 19 February 2013. Accessed at http://healthaffairs.org/blog/2013/02/19/continued-growth-of-public-and-private-accountable-care-organizations on 3 March 2014. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Weill Cornell Medical College, New York, New York.Financial Support: Dr. Ryan is supported by a grant from the Agency for Healthcare Research and Quality (K01 HS018546-01). Dr. Press is supported in part by funds provided to him as a Nanette Laitman Clinical Scholar in Public Health at Weill Cornell Medical College.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1715.Corresponding Author: Andrew M. Ryan, PhD, Department of Public Health, Weill Cornell Medical College, 402 East 67th Street, Room LA-215, New York, NY 10021; e-mail, [email protected]cornell.edu.Author Contributions: Conception and design: A.M. Ryan, M.J. Press.Analysis and interpretation of the data: A.M. Ryan.Drafting of the article: A.M. Ryan.Critical revision of the article for important intellectual content: A.M. Ryan, M.J. Press.Final approval of the article: A.M. Ryan. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLongitudinal participation in delivery and payment reform programs among US Primary Care OrganizationsLinking Quality and Spending to Measure Value for People with Serious IllnessLinking Spending and Quality Indicators to Measure Value and Efficiency in Health CarePay-for-PerformanceUS Physician Practices Spend More Than $15.4 Billion Annually To Report Quality MeasuresHigher Incentive Payments in Medicare Advantage's Pay-for-Performance Program Did Not Improve Quality But Did Increase Plan OfferingsApple Pickers or Federal Judges: Strong versus Weak Incentives in Physician Payment 15 April 2014Volume 160, Issue 8Page: 565-566KeywordsDisclosureForecastingHealth careHealth care qualityMedicareMotivationPrevention, policy, and public healthResearch design ePublished: 15 April 2014 Issue Published: 15 April 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. 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