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Physician Value-Based Payment Modifier To Make Changes for Hospitalists


 

“No man is an island.” Many of the reforms included in the Affordable Care Act (ACA) and other major healthcare legislation in the past decade put that sentiment into practice. This is a seismic shift in medicine and one that will reshape the way consumers and providers understand and relate to the healthcare system.

For consumers, the mandate to maintain health insurance coverage suggests the existence of a shared responsibility around health and wellness. This idea of community is central to many of the reforms for providers, as well. Value-based payment programs for both physicians and hospitals suggest that, given a scarce set of healthcare resources, we should be making sure that what Medicare is purchasing is of value. Even more telling, value is increasingly considered within a context of team-based and coordinated care. The future of healthcare, it seems, is pinned squarely on working together toward a common good.

The Physician Value-Based Payment Modifier (VBPM) is complementary to hospital value-based purchasing, moving the basis of physician payment toward the quality of care delivered, not simply the quantity of services rendered. The cost measures in the VBPM are unambiguously aligned with this ethos of community. Resource use per beneficiary is evaluated as an expression of the total costs borne by the healthcare system annually or within the context of an episode of care. So, in the value modifier, hospitalist groups can expect to see not just the costs that they charge, but also the costs of other physicians and other groups caring for the same Medicare patients. This is an explicit recognition of the myriad of providers engaged with each patient and their collective impact on the healthcare system.

At the same time, the VBPM strives to compare physicians by specialty, acknowledging that these separate communities within the healthcare system have different costs, patterns, and norms. For hospitalists, this comparison highlights some of the complexities of professional identity in what is still a relatively new field. For the measures to be meaningful and actionable, it is critical that comparisons be made amongst like providers.

SHM, through its Public Policy Committee and Performance Measurement and Reporting Committee, is diligently working to ensure that hospitalists are able to report on quality measures that make sense for their practices and that assessments are based on applicable and useful data for quality improvement. At the same time, these committees are working to ensure that hospitalists are evaluated using fair comparisons. In other words, hospitalists should be compared with other hospitalists.

At SHM’s annual meeting next month in Las Vegas (www.hospitalmedicine2014.org), healthcare reform will be discussed in greater detail during two sessions. One will focus on the current state of the ACA and reform efforts in general, and the other will be a workshop focusing specifically on participation in the VBPM. It is imperative that hospitalists are prepared to be successful as many of these changes unfold.


Joshua Lapps is SHM’s government relations specialist.

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