Value-based pay models slowly gain greater acceptance among physicians, may discourage providers from caring for high-risk patients

Compared with two years ago, more family physicians say their practices are actively pursuing value-based payment (VBP) opportunities, and more are hiring or have hired care coordinators and behavioral health support to prepare for value-based care.

The findings are from the 2017 Value-based Payment study, which was conducted by the American Academy of Family Physicians (AAFP) and funded by Humana.
Nearly half of the AAFP members who completed the survey—47 percent—said they are actively pursuing VBP opportunities, compared with 44 percent who gave a similar response in the 2015 study. But, that means that more than half still are not seeking out such opportunities.

Another positive finding is that significantly more respondents in this year’s survey indicated that payments based on quality measures were distributed to physicians in their practice (37 percent vs. 18 percent in 2015). Almost one-third of the respondents (31 percent) said they didn’t know how value-based payments were distributed in their practice.

However, fewer respondents agreed that “quality expectations are easy to meet in value-based payment models” (8 percent in 2017 vs. 13 percent in 2015), and 62 percent of the respondents in both years indicated that “lack of evidence that using performance measures results in better patient care” was a barrier to adopting value-based care.

In both years a similar proportion of respondents agreed with the statement that value-based payments “will increase work for physicians without a benefit to the patient” (58 percent in 2017 vs. 59 percent in 2015).

Separately, a study published last week in the Annals of Internal Medicine found that practices that provided care for high-risk patients were more likely to incur financial penalties under CMS’ Value-based Payment Modifier program, which penalized or rewarded physicians based on quality outcomes and cost of care.

“These penalties are disproportionately affecting practices serving sicker and poorer patients,” Eric Roberts, one of the study’s authors and an assistant professor of health policy and management at the University of Pittsburgh, told Modern Healthcare. “This could send providers the wrong signal that if they want to avoid penalties, treating more complex patients isn’t advantageous for them,” he added.

Moreover, the study also found that outcomes did not improve after the Value-based Payment Modifier program took effect, despite the financial penalties for lack of improvement. Roberts said one reason might have been the program’s “weak incentives for behavior change.”

Starting in 2017, the Value-based Payment Modifier program was merged into the Merit-based Incentive Payment System’s Quality and Cost categories.