VBMs: Coming Soon to Either Increase or Lower Your Income

Kenneth J. Terry, MA


February 06, 2014

In This Article

Panic Calls From Physicians

Few physicians are even aware of the VBM, said David J. Zetter, a practice management consultant in Mechanicsburg, Pennsylvania. Because they have so many other things to deal with, ranging from meaningful use and the 10th edition of the International Classification of Diseases (ICD-10) to the impending SGR and sequestration cuts, many doctors won't know what hit them when they start seeing VBM reimbursement cuts in 2015 and 2016, he noted.

Right now, he said, he's getting "panic calls" from doctors who haven't yet applied to the electronic health record incentive program and see meaningful use penalties on the horizon. There's also a high level of concern about ICD-10, which is directly related to how doctors get paid.

"Most doctors are too busy dealing with everything else to worry about things that are going to happen 3-4 years down the road. They don't have that mindset."

One way to avoid the VBM is to join an ACO that is part of the Medicare shared savings program. Physicians should find out all they can about local ACO initiatives, Zetter said, but they shouldn't participate in an ACO just to sidestep the VBM. They have to think about such issues as what the ACO will cost them, whether they will have input into its decisions, and whether the ACO takes financial risk from payers.

One way to prepare for the VBM, Zetter added, is to review the quality and resource use reports from CMS. Although those reports may not reveal exactly how much improvement is required, they can at least give practices some indication of where they stand in relation to their peers, he noted.

How One Group Is Coping

The Summit Medical Group in Summit, New Jersey, welcomes the advent of the VBM but has decided not to put any of its Medicare reimbursement at risk in 2015. The group, which includes 400 providers, 300 of them physicians, is going through a growth spurt, explained Robert Brenner, Summit's Chief Medical Officer. "We're taking on loads of new physicians, and we don't have an understanding of their baseline quality yet. So for us to go for a Medicare bonus using the VBM would have been too risky."

On the basis of the feedback reports that Summit has received from CMS, however, Brenner is confident that the group would have done well if it had been judged on the performance of the doctors who have been with the group for a while.

Summit has a comprehensive quality improvement program that will help it do well in the VBM program, Brenner said. "We're constantly working on how we do across the board, and we don't separate it by payer. Whether it's CMS or our commercial payers, we're monitoring the key metrics for each specialty."

To prepare for the VBM, he added, Summit will pay special attention to the PQRS metrics and the CMS feedback reports.

Brenner favors replacing the SGR approach of CMS with a value-based payment method, such as the one proposed in current Congressional bills.

"I'd be in favor of any proposal that rewards a high-performing group," he said. "I believe we're a high-performing group, and we should be paid for all of the resources that we're putting into quality improvement. And those that are not high-performing and don't have the outcomes should not get that payment."


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