Value-based payment modifier program not associated with differences in performance program measures

1. Taking into account additional patient characteristics largely influenced performance differences between practices serving high and low risk patients.

2. The value-based payment modifier program was not associated with differences in performance program measures

Evidence Rating Level: 2 (Good)

Study Rundown: Value-based payment modifier programs (VM) reward physicians for improving quality of care and reducing spending. The authors of this study aimed to determine the relationship between VM exposure and performance on quality and spending measures. Additionally, they wanted to determine whether adjusting for patient characteristics, including taking into account practices that serve high risk versus low risk patients, had an impact on the results. It was observed that when taking into account the different patient characteristics, there were large impacts on performances differences between practices. This study has several limitations. Largely, the authors could not adjust for all patient characteristic differences between practices. Factors such as education, cognition, and self-reported health status were not incorporated into the study.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: Introduction to Value-Based Payment Modifiers

In-Depth [retrospective cohort]: The authors of the study assessed several performance variables, including differences in hospitalization for ambulatory care-sensitive conditions (ASCSs), readmissions, Medicare spending, and mortality between practices. The authors used cross-sectional regression discontinuity design for the first set of analyses, and compared practice performance before versus after adjusting for patient characteristics for the second set of analyses. They observed that the practices serving high-risk populations had higher races of hospitalization for ACSCs, Medicare spending, and mortality. Performance differences between practices also different significantly when taking into account other patient characteristics. Overall, the results of the study suggest that the financial incentives in the VM were not associated with significant differences in performance variables.

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