Practices serving a disproportionate number of severe high-risk patients could be at risk of receiving more financial penalties under value-based payment programs, according to a study published in JAMA.
Researchers — led by Lena Chen, MD, with the division of general medicine in the department of internal medicine at Ann Arbor-based University of Michigan — examined if an association existed between patients' social or medical risk and providers' performance during the first year of the Medicare physician value-based payment modifier program.
Study authors conducted a cross-sectional observational study analyzing physician value-based payment modifier program data for payments issued in 2015. Data comprised performance of 899 large physician practices serving more than 5 million fee-for-service Medicare members in 2013. Practices were categorized as high social risk if they ranked in the top quartile of proportion of patients eligible for Medicare and Medicaid, and high medical risk if in the top quartile of average risk scores among fee-for-service members.
Of the 899 practices, the study categorized 128 practices as high medical risk, 102 as high social risk and 122 as high medical and social risk practices. Low-risk practices accounted for 547 of studied practices.
Low-risk practices performed the best on quality scores compared to high medical and social-risk practices. Across the categorizations, per capita costs were $9,506 for low-risk practices, $13,683 for high medical-risk practices, $8,214 for high social-risk practices and $11,692 for high medical and social-risk practices.
"During the first year of the Medicare physician value-based payment modifier program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs," the authors concluded. "These patterns were associated with fewer bonuses and more penalties for high-risk practices."