Medicare Value-based Care Program Penalizes Physicians Serving High-risk Patients

A new paper in the Journal of the American Medical Association (JAMA) has indicated that value-based payments to physicians in the Medicare program penalize those who serve socially or medically high-risk patients.

The study investigated first year results for the Physician Value-Based Payment Modifier (PVBM) Program. It found that practices that served high-risk patients had lower quality in general. Those serving socially high-risk patients had lower costs, while those serving medically high-risk had higher costs.

In each case, these practices received fewer bonuses and faced greater financial penalties.

“As value-based payment programs continue to increase in size and scope, practices that disproportionately serve high-risk patients may be at particular risk of receiving financial penalties,” wrote the study’s authors.

The study underlines a central difficulty facing value-based care and similar outcomes-driven payment models. Outcomes are driven not just by the quality of care, but also the characteristics of the population served. Without sufficient focus on value-added, programs working with disadvantaged populations may be penalized.


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