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PQRS and VBP Is Mixing Politics and Money; What Could Be More Dicey


Just for level setting, value=quality/cost. Unfortunately, physician payment structure still rewards volume over quality, hence the continued rising cost, and lack of improvement in the value proposition.

Although most physicians believe that the current structure does not adequately financially reward providers for quality, only 1/3 support public reporting.

A pertinent quotation: “If the MDs don’t develop quality measures, the MBAs will.”

The PQRS program is currently elective, with nominal payment incentives, but will become a negative incentive for non-participating providers in 2015. The next step will be the physician feedback program (known as PRUR), which will evolve into the VBP program by physician. Similar to the hospital VBP program, it will be budget neutral, and will be piloted in selected physician groups in 4 states, then rolled out to all physicians in 2017.

Key takeaways for Hospitalists:

  • CMMS is moving from public reporting → pay for VALUE performance, for all physicians, through the PQRS → PRUR → VBP programs.
  • All physicians need to familiarize themselves with the data and the attribution models.
  • All physicians need to gain QI skills to improve their performance metrics.

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