Public Policy

Hospitalists Encouraged to Embrace Medicare’s VBPM Program Now


Because VBPM sets a two-year time lag between performance year and payment adjustment, the first adjustments in 2015 will be based on data gathered this year.

Hospitalists have heard ad infinitum that, starting this year, providers in groups of 100 or more might be penalized in two years by the Centers for Medicare & Medicaid Services’ (CMS) value-based payment modifier (VBPM) program, which correlates the cost of services to the quality of those services. And while it is true VBPM won’t apply to individual providers until 2017, HM leaders say now is the time to lobby on what metrics should be considered to determine clinician quality.

“With the speed at which policy becomes reality, we need to start now,” says Gregory Seymann, MD, SFHM, chief of the division of hospital medicine at the University of California at San Diego School of Medicine. “The trick about the immediacy is that it appears that it’s four years away because 2017 is when it applies to everyone. That’s deceptive; they start measuring performance for 2017 in 2015. The immediacy is real for everyone.”

VBPM: The Next Step

VBPM is a separate program from, but overlaps with, the Physician Quality Reporting System (PQRS). In essence, PQRS was a pay-for-reporting system that rewarded compliant physicians a 0.5% incentive payment for total Medicare Part B Physician Fee Schedule (PFS) charges for covered services (which means the incentive covers all PFS payments, not just those applied to the services being reported). The landmark Affordable Care Act (ACA) has gone a step further: Nonparticipating physicians will lose 1.5% of allowable Medicare charges beginning in 2015. The reimbursement reduction increases to 2% in 2016.

Once a group is participating in PQRS, VBPM is the next step: a pay-for-quality system that will offers variable rewards for the most efficient providers and a 1% penalty for those groups that fail to participate. Because VBPM sets a two-year time lag between performance year and payment adjustment, the first adjustments in 2015 will be based on data gathered this year.

For the 2015 adjustment, CMS only is looking at results from groups of 100 or more eligible professionals—currently defined as physicians, practitioners, and therapists—under a lone tax identification number (TIN). Hospitalists in large groups or at large academic centers could be eligible, as billing for those physicians often is done in tandem with other specialties, says Dr. Seymann, a member of SHM’s Performance Measurement and Reporting Committee (PMRC). He recommends hospitalists check with administrators to learn if they are in such a group.

Payment adjustments for individual providers will begin in 2017 and likely will be based on a 2015 performance period. PMRC chair Patrick Torcson, MD, MMM, FACP, SFHM, says the time is now for SHM and providers to lobby for the right metrics to be used. Dr. Torcson’s first priority would be for Medicare to recognize HM as its own specialty, as current measures don’t correctly capture the activities on which most hospitalists focus.

“The performance measures that are available for hospitalists really are for general internal medicine and are just left over because we’re lumped in with the internists,” he says. “For example, there may be a heart failure measure or a pneumonia measure, and hospitalists treat a lot of heart failure and pneumonia, but the way that the measure is specified is that it has specifications that can only be reported in the outpatient setting. So the inpatient setting doesn’t allow for a hospitalist to be able to report.”

Suboptimal Measures

Dr. Seymann notes that tailoring measures to patient discharge and transitions of care could provide metrics that would better measure the quality of care provided by hospitalists. SHM and others have lobbied for such metrics, but CMS has not weighed in yet. Dr. Seymann adds CMS has asked for feedback on whether physicians should be allowed to align their reporting with the quality measures required for hospitals’ Inpatient Hospital Quality Reporting (IHQR) measures. SHM has supported the idea, as long as hospitalists aren’t required to report that way.

“Hospitalists can say, ‘If my hospital does well on these measures, that’s a reflection of my contribution as well, so we can count these measures for our value-based modifier,’” he says. “Those are promising pathways to more options for hospitalists.”

Dr. Torcson urges physicians to lobby their local federal officials and Medicare contacts to ensure that when all hospitalists are subject to the VBPM, the most accurate metrics available are used to gauge their quality of care delivery.

“Ideally, for a hospital medicine practice to be measured and have relevant outcomes, it would have to include performance measures that address things like transitions of care, medication reconciliation, patient safety, efficiency, and use of resources,” he says. “We’re really in the infancy of the methodology and performance measurement world of having relevant measures that do address those specific things. That’s on our hospitalist wish list.”

Richard Quinn is a freelance writer in New Jersey.

What Can I Do Now?

An additive effect

SHM has lobbied federal officials for changes to CMS’ Value-Based Payment Modifier Program, and will continue to do so. But here are tips individual providers can use now:

  • Make sure your group is participating in PQRS. While that might sound commonplace, CMS data showed that in 2010, roughly 25% of eligible providers were participating in PQRS’ optional predecessor, the Physician Quality Reporting Initiative (PQRI).
  • Find out how your workplace handles its billing. If your billing is submitted with other specialties and physicians from inside the institution, you might be in a group of 100 eligible providers. If so, your compliance with PQRS measures this year will determine your payment adjustment in 2015.
  • Pay attention to Medicare’s QRUR. 2013 is the first year all physicians will receive the report, which was launched last year as a pilot program in just nine states. The reports essentially rank providers based on cost and quality of care, and can be skewed for hospitalists as the measures don’t necessarily take into account that hospitalists often care for the acutely ill. SHM has lobbied CMS to improve the reports so they are more accurate in relation to HM services, but the more examples SHM can provide, the more weight the argument will likely hold.

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