New Report Highlights Challenges in Face of Value Based Care

Sarasota, FL (WorkersCompensation.com) – Value-based care payer agreements are contracts in which providers are paid based on health outcomes of their patients. Driven and determined by reporting and trending, in value-based arrangements providers and payers both share in the financial risk.  Unable to secure an increase in fee for service reimbursement rates for several years, providers have entertained more value-based agreements with payers. According to a recent report from the Medical Group Management Association (MGMA), providers have much to figure out in navigating value-based care in the midst of post-pandemic challenges.

MGMA analyzed 2021 data from a poll of 2,300 healthcare groups, which was made up of different specialties and practice sizes, on some of their challenges to maintain quality. The results of the survey indicated that some practices are facing longer wait times, higher no-show and cancellation rates, all of which ultimately impact value-based care.

While the payer trend has been to move away from fee for service, analysts found that value based contracts accounted for a small percentage of provider revenue, but varied across specialty. With an average value-based income of $30,922 per provider, value-based payments only made up 6.74 percent of primary care revenue, 5.54 percent surgical specialties revenue, and 14.74 percent or revenue for nonsurgical specialties. 

With payers moving to pay for performance, healthcare practices are adopting the same approach internally. In 2016, only 26 percent of practices compensated their physicians based on outcome. By 2018, that percentage increased to 36 percent, and in 2019 the percentage increased again to 38 percent. In 2021, 42 percent of practices stated that quality factored in physician compensation. When asked how quality compensation had changed during the pandemic, 35 percent stated that they had increased the share of compensation tied to quality within the past 2 years. Sixty-two percent stated that they had remained neutral, and only 2 percent stated that they had decreased the percentage of compensation based on quality outcomes.

One hurdle in quality however is the logistics of patient care. According to the MGMA poll, wait times for appointments for new and established patients has increased by as much as two days on average. Average new patient appointment availability increased from 6.1 days in 2020 to 8.1 days in 2021. The average wait time for established patients increased from 4 days in 2020 to 4.43 days in 2021.

Additionally, wait times in the waiting room and the exam room increased. The average wait times increased to 16 minutes for the waiting area, and 9 minutes in the exam room. One of the top challenges cited in managing patients efficiently were appropriate staffing levels, as well as space.

Only 16 percent of practices polled stated that their 2022 visit levels were below 2021 levels. Thirty percent reported their visit levels were about the same, and 55 percent stated that their 2022 visit levels had actually increased. While the majority of practices stated that their visits had increased, around half at 49 percent stated that their no-show rate had increased as well. According to the MGMA report, better performance was tied to longer hours of operation. For primary care, better performers were open for three more hours a week than the average. For nonsurgical practices, better performers were open for 4.5 hours longer, and for surgical specialties better performers were open for five more hours per week.

Though payers and employers have a value based care system in sight, it remains to be seen whether or not the goal is ultimately realistic. While clinical care has been the main focus for outcomes, the reality is that non-clinical elements of healthcare are a big driver of outcomes that are often overlooked and un-addressed. To further complicate matters, practices are often limited on reporting that can help determine where the bottlenecks of care are actually occurring. While fee for service reporting is readily available in practice management systems, providers struggle to access case level reporting that is accurate and gives a clear picture. In order to efficiently move to a sustainable value based care model, doing so will most certainly require a holistic type approach.

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