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Volumn 168, Issue 4, 2018, Pages 255-265

The value-based payment modifier: Program outcomes and implications for disparities

Author keywords

[No Author keywords available]

Indexed keywords

AMBULATORY CARE; ARTICLE; HEALTH CARE DISPARITY; HEALTH CARE QUALITY; HIERARCHICAL CONDITION CATEGORY SCORE; HIGH RISK PATIENT; HOSPITAL READMISSION; HOSPITALIZATION; HUMAN; LOW RISK PATIENT; LOWEST INCOME GROUP; MEDICAID; MEDICAL FEE; MEDICARE; MORTALITY; OUTCOME ASSESSMENT; PRIORITY JOURNAL; SCORING SYSTEM; AGED; ECONOMICS; FEMALE; GOVERNMENT; HEALTH CARE COST; MALE; REIMBURSEMENT; RISK ASSESSMENT; UNITED STATES;

EID: 85042293587     PISSN: 00034819     EISSN: 15393704     Source Type: Journal    
DOI: 10.7326/M17-1740     Document Type: Article
Times cited : (98)

References (48)
  • 1
    • 85020339954 scopus 로고    scopus 로고
    • Final rule with comment period
    • Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models., [PMID: 27905815]
    • Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models. Final rule with comment period. Fed Regist. 2016;81:77008-831. [PMID: 27905815].
    • (2016) Fed Regist , vol.81 , pp. 77008-77831
  • 2
    • 84924128998 scopus 로고    scopus 로고
    • Setting value-based payment goals-HHS efforts to improve U.S. Health care
    • PMID: 25622024
    • Burwell SM. Setting value-based payment goals-HHS efforts to improve U.S. health care. N Engl J Med. 2015;372:897-9. [PMID: 25622024] doi:10.1056/NEJMp1500445.
    • (2015) N Engl J Med , vol.372 , pp. 897-899
    • Burwell, S.M.1
  • 3
    • 84869753450 scopus 로고    scopus 로고
    • Linking performance with payment: Implementing the physician value-based payment modifier
    • PMID: 23198298
    • Van Lare JM, Blum JD, Conway PH. Linking performance with payment: implementing the Physician Value-Based Payment Modifier. JAMA. 2012;308:2089-90. [PMID: 23198298].
    • (2012) JAMA , vol.308 , pp. 2089-2090
    • Van Lare, J.M.1    Blum, J.D.2    Conway, P.H.3
  • 4
    • 84937116277 scopus 로고    scopus 로고
    • Medicare payment reform: Aligning incentives for better care
    • PMID: 26151988
    • Anderson GF, Davis K, Guterman S. Medicare payment reform: Aligning incentives for better care. Issue Brief (Commonw Fund). 2015;20:1-12. [PMID: 26151988].
    • (2015) Issue Brief (Commonw Fund) , vol.20 , pp. 1-12
    • Anderson, G.F.1    Davis, K.2    Guterman, S.3
  • 5
    • 84974816058 scopus 로고    scopus 로고
    • Early performance of accountable care organizations in Medicare
    • PMID: 27075832
    • McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL. Early performance of accountable care organizations in Medicare. N Engl J Med. 2016;374:2357-66. [PMID: 27075832] doi:10.1056/NEJMsa1600142.
    • (2016) N Engl J Med , vol.374 , pp. 2357-2366
    • McWilliams, J.M.1    Hatfield, L.A.2    Chernew, M.E.3    Landon, B.E.4    Schwartz, A.L.5
  • 6
    • 84922016552 scopus 로고    scopus 로고
    • Medicare program; revisions to payment policies under the physician fee schedule, clinical laboratory fee schedule, access to identifiable data for the Center for Medicare and Medicaid Innovation Models & other revisions to Part B for CY 2015
    • Centers for Medicare & Medicaid Services
    • Centers for Medicare & Medicaid Services. Medicare program; revisions to payment policies under the physician fee schedule, clinical laboratory fee schedule, access to identifiable data for the Center for Medicare and Medicaid Innovation Models & other revisions to Part B for CY 2015. Fed Regist. 2014; 79:67931-41.
    • (2014) Fed Regist , vol.79 , pp. 67931-67941
  • 7
    • 85042286888 scopus 로고    scopus 로고
    • Centers for Medicare & Medicaid Services. Updated 21 September 2017. Accessed at, on 10 December 2016
    • Centers for Medicare & Medicaid Services. Timeline to phase in the Value-Based Payment Modifier. Updated 21 September 2017. Accessed at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Timeline.html on 10 December 2016.
    • Timeline to Phase in the Value-Based Payment Modifier
  • 8
    • 85028504654 scopus 로고    scopus 로고
    • Centers for Medicare & Medicaid Services. Baltimore: Centers for Medicare & Medicaid Services
    • Centers for Medicare & Medicaid Services. 2015 Value-Based Payment Modifier Program Experience Report. Baltimore: Centers for Medicare & Medicaid Services; 2015.
    • (2015) 2015 Value-Based Payment Modifier Program Experience Report
  • 9
    • 84892618182 scopus 로고    scopus 로고
    • Medicare program; revisions to payment policies under the physician fee schedule, clinical laboratory fee schedule & other revisions to Part B for CY 2014. Final rule with comment period
    • Centers for Medicare & Medicaid Services (CMS), HHS., [PMID: 24340356]
    • Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program; revisions to payment policies under the physician fee schedule, clinical laboratory fee schedule & other revisions to Part B for CY 2014. Final rule with comment period. Fed Regist. 2013;78: 74229-823. [PMID: 24340356].
    • (2013) Fed Regist , vol.78 , pp. 74229-74823
  • 13
    • 85042305327 scopus 로고    scopus 로고
    • Medicare penalties for 5477 groups fund bonuses for 128
    • Accessed at, on 8 January 2017
    • Lowes R. Medicare penalties for 5477 groups fund bonuses for 128. Medscape. 2016. Accessed at www.medscape.com/viewarticle/860103 on 8 January 2017.
    • (2016) Medscape
    • Lowes, R.1
  • 17
    • 85042301713 scopus 로고    scopus 로고
    • U.S. Department of Health and Human Services. Washington, DC: U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation
    • U.S. Department of Health and Human Services. Report to Congress: Social Risk Factors and Performance Under Medicare's Value- Based Payment Programs. Washington, DC: U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation; 2016.
    • (2016) Report to Congress: Social Risk Factors and Performance under Medicare's Value- Based Payment Programs
  • 18
    • 85012852426 scopus 로고    scopus 로고
    • Social risk factors and equity in Medicare payment
    • PMID: 28177864
    • Buntin MB, Ayanian JZ. Social risk factors and equity in Medicare payment. N Engl J Med. 2017;376:507-10. [PMID: 28177864] doi:10.1056/NEJMp1700081.
    • (2017) N Engl J Med , vol.376 , pp. 507-510
    • Buntin, M.B.1    Ayanian, J.Z.2
  • 19
    • 84995930485 scopus 로고    scopus 로고
    • National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Board on Health Care Services; Committee on Accounting for Socioeconomic Status in Medicare Payment Programs. Washington, DC: National Academies Pr
    • National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Board on Health Care Services; Committee on Accounting for Socioeconomic Status in Medicare Payment Programs. Accounting for Social Risk Factors in Medicare Payment: Data. Washington, DC: National Academies Pr; 2016.
    • (2016) Accounting for Social Risk Factors in Medicare Payment: Data
  • 20
    • 84904261607 scopus 로고    scopus 로고
    • Quality reporting that addresses disparities in health care
    • PMID: 25027134
    • Jha AK, Zaslavsky AM. Quality reporting that addresses disparities in health care. JAMA. 2014; 312: 225-6. [PMID: 25027134] doi:10.1001/jama.2014.7204.
    • (2014) JAMA , vol.312 , pp. 225-226
    • Jha, A.K.1    Zaslavsky, A.M.2
  • 21
    • 85025093526 scopus 로고    scopus 로고
    • MACRA: Big fix or big problem?
    • PMID: 28505630
    • McWilliams JM. MACRA: big fix or big problem? Ann Intern Med. 2017;167:122-4. [PMID: 28505630] doi:10.7326/M17-0230.
    • (2017) Ann Intern Med , vol.167 , pp. 122-124
    • McWilliams, J.M.1
  • 22
    • 85027520203 scopus 로고    scopus 로고
    • Association of practice-level social and medical risk with performance in the medicare physician value-based payment Modifier Program
    • PMID: 28763549
    • Chen LM, Epstein AM, Orav EJ, Filice CE, Samson LW, Joynt Maddox KE. Association of practice-level social and medical risk with performance in the Medicare Physician Value-Based Payment Modifier Program. JAMA. 2017;318:453-61. [PMID: 28763549] doi:10.1001/jama.2017.9643.
    • (2017) JAMA , vol.318 , pp. 453-461
    • Chen, L.M.1    Epstein, A.M.2    Orav, E.J.3    Filice, C.E.4    Samson, L.W.5    Joynt, M.K.E.6
  • 23
    • 84890895177 scopus 로고    scopus 로고
    • Will value-based purchasing increase disparities in care?
    • PMID: 24369072
    • Ryan AM. Will value-based purchasing increase disparities in care? N Engl J Med. 2013;369:2472-4. [PMID: 24369072] doi:10.1056/NEJMp1312654.
    • (2013) N Engl J Med , vol.369 , pp. 2472-2474
    • Ryan, A.M.1
  • 24
    • 84946139292 scopus 로고    scopus 로고
    • Patient characteristics and differences in hospital readmission rates
    • PMID: 26368317
    • Barnett ML, Hsu J, McWilliams JM. Patient characteristics and differences in hospital readmission rates. JAMA Intern Med. 2015; 175:1803-12. [PMID: 26368317] doi:10.1001/jamainternmed.2015.4660.
    • (2015) JAMA Intern Med , vol.175 , pp. 1803-1812
    • Barnett, M.L.1    Hsu, J.2    McWilliams, J.M.3
  • 25
    • 84960337572 scopus 로고    scopus 로고
    • Variation in accountable care organization spending and sensitivity to risk adjustment: Implications for benchmarking
    • PMID: 26953298
    • Rose S, Zaslavsky AM, McWilliams JM. Variation in accountable care organization spending and sensitivity to risk adjustment: implications for benchmarking. Health Aff (Millwood). 2016;35:440-8. [PMID: 26953298] doi:10.1377/hlthaff.2015.1026.
    • (2016) Health Aff (Millwood) , vol.35 , pp. 440-448
    • Rose, S.1    Zaslavsky, A.M.2    McWilliams, J.M.3
  • 26
    • 0036675810 scopus 로고    scopus 로고
    • Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs
    • PMID: 12187185
    • Franks P, Fiscella K. Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs. Med Care. 2002;40:717-24. [PMID: 12187185].
    • (2002) Med Care , vol.40 , pp. 717-724
    • Franks, P.1    Fiscella, K.2
  • 27
    • 77958101847 scopus 로고    scopus 로고
    • Paying for performance in primary care: Potential impact on practices and disparities
    • PMID: 20439882
    • Friedberg MW, Safran DG, Coltin K, Dresser M, Schneider EC. Paying for performance in primary care: potential impact on practices and disparities. Health Aff (Millwood). 2010;29:926-32. [PMID: 20439882] doi:10.1377/hlthaff.2009.0985.
    • (2010) Health Aff (Millwood) , vol.29 , pp. 926-932
    • Friedberg, M.W.1    Safran, D.G.2    Coltin, K.3    Dresser, M.4    Schneider, E.C.5
  • 28
    • 84962551969 scopus 로고    scopus 로고
    • Regression discontinuity designs in healthcare research
    • PMID: 26977086
    • Venkataramani AS, Bor J, Jena AB. Regression discontinuity designs in healthcare research. BMJ. 2016; 352:i1216. [PMID: 26977086] doi:10.1136/bmj.i1216.
    • (2016) BMJ , vol.352 , pp. i1216
    • Venkataramani, A.S.1    Bor, J.2    Jena, A.B.3
  • 29
    • 85042284123 scopus 로고    scopus 로고
    • Centers for Medicare & Medicaid Services. Baltimore: Centers for Medicare & Medicaid Services
    • Centers for Medicare & Medicaid Services. Two-Step Attribution for Measures Included in the Value Modifier. Baltimore: Centers for Medicare & Medicaid Services; 2015.
    • (2015) Two-Step Attribution for Measures Included in the Value Modifier
  • 30
    • 85042280667 scopus 로고    scopus 로고
    • Centers for Medicare & Medicaid Services; Research Data Assistance Center. October 2016. Accessed at, on 8 January 2017
    • Centers for Medicare & Medicaid Services; Research Data Assistance Center. Shared Savings Program Accountable Care Organizations (ACO) provider-level research identifiable files. October 2016. Accessed at www.resdac.org/cms-data/files/ssp-Aco-provider-level-rif on 8 January 2017.
    • Shared Savings Program Accountable Care Organizations (ACO) Provider-level Research Identifiable Files
  • 31
    • 85042298868 scopus 로고    scopus 로고
    • Centers for Medicare & Medicaid Services. Accessed at, on 20 December 2016
    • Centers for Medicare & Medicaid Services. Medicare data on provider practice and specialty (MD-PPAS). 2016. Accessed at www.resdac.org/cms-data/files/md-ppas on 20 December 2016.
    • (2016) Medicare Data on Provider Practice and Specialty (MD-PPAS)
  • 34
    • 78751469926 scopus 로고    scopus 로고
    • Regression discontinuity designs in economics
    • Lee DS, Lemieux T. Regression discontinuity designs in economics. J Econ Lit. 2010;48:281-355.
    • (2010) J Econ Lit , vol.48 , pp. 281-355
    • Lee, D.S.1    Lemieux, T.2
  • 36
    • 85020339954 scopus 로고    scopus 로고
    • Medicare program; Merit-based incentive payment system (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physicianfocused payment models
    • Centers for Medicare & Medicaid Services; U.S. Department of Health and Human Services., 77338
    • Centers for Medicare & Medicaid Services; U.S. Department of Health and Human Services. Medicare program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physicianfocused payment models. Fed Regist. 2016; 81:77338.
    • (2016) Fed Regist , vol.81
  • 37
    • 85018342604 scopus 로고    scopus 로고
    • Centers for Medicare & Medicaid Services. Accessed at, on 20 October 2016
    • Centers for Medicare & Medicaid Services. Computation of the 2016 value modifier. 2015. Accessed at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Fact-Sheet.pdf on 20 October 2016.
    • (2015) Computation of the 2016 Value Modifier
  • 38
    • 85042317703 scopus 로고    scopus 로고
    • National Association of ACOs. Washington, DC: National Association of ACOs
    • National Association of ACOs. The ACOs Guide to MACRA. Washington, DC: National Association of ACOs; 2016:25-37.
    • (2016) The ACOs Guide to MACRA , pp. 25-37
  • 40
    • 84930426040 scopus 로고    scopus 로고
    • Association of pioneer accountable care organizations vs traditional Medicare fee for service with spending, utilization, and patient experience
    • PMID: 25938875
    • Nyweide DJ, Lee W, Cuerdon TT, Pham HH, Cox M, Rajkumar R, et al. Association of pioneer accountable care organizations vs traditional Medicare fee for service with spending, utilization, and patient experience. JAMA. 2015;313:2152-61. [PMID: 25938875] doi:10.1001/jama.2015.4930.
    • (2015) JAMA , vol.313 , pp. 2152-2161
    • Nyweide, D.J.1    Lee, W.2    Cuerdon, T.T.3    Pham, H.H.4    Cox, M.5    Rajkumar, R.6
  • 41
    • 84929377779 scopus 로고    scopus 로고
    • Performance differences in year 1 of pioneer accountable care organizations
    • PMID: 25875195
    • McWilliams JM, Chernew ME, Landon BE, Schwartz AL. Performance differences in year 1 of pioneer accountable care organizations. N Engl J Med. 2015;372:1927-36. [PMID: 25875195] doi:10.1056/NEJMsa1414929.
    • (2015) N Engl J Med , vol.372 , pp. 1927-1936
    • McWilliams, J.M.1    Chernew, M.E.2    Landon, B.E.3    Schwartz, A.L.4
  • 42
    • 84997107182 scopus 로고    scopus 로고
    • Changes in Medicare shared savings program savings from 2013 to 2014 [Letter]
    • PMID: 27612292
    • McWilliams JM. Changes in Medicare shared savings program savings from 2013 to 2014 [Letter]. JAMA. 2016;316:1711-3. [PMID: 27612292] doi:10.1001/jama.2016.12049.
    • (2016) JAMA , vol.316 , pp. 1711-1713
    • McWilliams, J.M.1
  • 43
    • 85018193564 scopus 로고    scopus 로고
    • Moving forward with accountable care organizations: Some answers, more questions
    • PMID: 28192555
    • Colla CH, Fisher ES. Moving forward with accountable care organizations: some answers, more questions. JAMA Intern Med. 2017; 177:527-8. [PMID: 28192555] doi:10.1001/jamainternmed.2016.9122.
    • (2017) JAMA Intern Med , vol.177 , pp. 527-528
    • Colla, C.H.1    Fisher, E.S.2
  • 46
    • 85042262795 scopus 로고    scopus 로고
    • How policymakers can foster organizational innovation in health care
    • 15 July 2016. Accessed at, on 10 September 2017
    • Glied S. How policymakers can foster organizational innovation in health care. Health Affairs Blog. 15 July 2016. Accessed at www.healthaffairs.org/do/10.1377/hblog20160715.055867/fullon 10 September 2017.
    • Health Affairs Blog
    • Glied, S.1
  • 47
    • 85014913165 scopus 로고    scopus 로고
    • Focusing on high-cost patients-The key to addressing high costs?
    • PMID: 28249127
    • McWilliams JM, Schwartz AL. Focusing on high-cost patients-The key to addressing high costs? N Engl J Med. 2017;376:807-9. [PMID: 28249127] doi:10.1056/NEJMp1612779.
    • (2017) N Engl J Med , vol.376 , pp. 807-809
    • McWilliams, J.M.1    Schwartz, A.L.2
  • 48
    • 84879579363 scopus 로고    scopus 로고
    • Cognition and take-up of subsidized drug benefits by Medicare beneficiaries
    • PMID: 23649604
    • Kuye IO, Frank RG, McWilliams JM. Cognition and take-up of subsidized drug benefits by Medicare beneficiaries. JAMA Intern Med. 2013;173:1100-7. [PMID: 23649604] doi:10.1001/jamainternmed.2013.845.
    • (2013) JAMA Intern Med. , vol.173 , pp. 1100-1107
    • Kuye, I.O.1    Frank, R.G.2    McWilliams, J.M.3


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.