Value-based care still a small fraction of medical revenue, MGMA finds

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While there's very little consensus when it comes to the definition of "value-based care," the healthcare industry continues to move away from fee-for-service – slowly. Though the concept isn't new, a new report from the Medical Group Management Association found that value-based care only accounts for a small portion of medical revenue in most specialties.

Data from the survey found that revenue from value-based contracts accounted for 6.74% of total medical revenue in primary care specialties, 5.54% in surgical specialties and 14.74% in nonsurgical specialties.

Across all practices, the median revenue amount from value-based contracts was $30,922 per provider.

The survey also provided key benchmarks for quality measures, based on covered lives attributed under value-based contracts. Median quality measure performance was 3% for hospital admission rate, 11% for 30-day readmission rate, 27% for emergency department utilization rate and 1% for 30-day postoperative infection rate.

MGMA Stat polling earlier this year found that the adoption of quality performance metrics in value-based contracts is also being reflected in updated physician compensation plans, as 42% of medical groups tie some element of quality-performance metrics to physician compensation plans.

Prior to the COVID-19 pandemic, previous MGMA Stat polls on this topic showed a very slow growth in the inclusion of quality metrics in compensation plans. About one in four (26%) medical groups tied quality performance to physician compensation in 2016. By July 2018, the share of groups with quality tied to compensation rose to 36%. A March 2019 poll – the last such poll MGMA Stat conducted on this topic prior to the pandemic – found that nearly 4 in 10 (38%) of groups had tied quality performance to physician compensation.

Respondents to the latest poll said the share of physician compensation tied to quality performance has changed during the pandemic. Thirty-five percent report they have increased the share of compensation tied to quality in the past two years, while 62% of medical groups have the same share of compensation tied to quality versus 2019 levels. Only 2% of respondents said they decreased the percentage of compensation tied to quality.

WHAT'S THE IMPACT?

The MGMA survey focused on value-based contracts but was wide-ranging and included trends on staffing.

Heightened competition for workers, compounded by several early retirements and healthcare workers leaving the industry for other sectors, has prompted staffing shortages across several positions in medical group practices that persist to this day.

The inability to optimize appointment schedules due to staffing shortages throughout much of 2021 resulted in appointment availability for new patients – measured as the third-next-available appointment – increasing by two days: from 6.1 days in 2020 to 8.1 days in 2021.

But time-to-third for established patients increased slightly, ticking up from four days in 2020 to 4.43 days in 2021. Wait times in a practice's waiting area also increased by four minutes year over year, with a median wait time of 16 minutes in 2021, while times in the exam room spent waiting for a provider increased by two minutes in 2021, reaching a median of nine minutes.

Meanwhile, overall usage of patient portals improved in 2021, with a 17% increase in patient logins compared to 2020. The top functions of patient portal usage that experienced an increase in utilization from 2020 to 2021 include paying bills through patient portal (a 29% increase), communicating with providers and medical staff (a 40% increase), and filling a new prescription (a 59% increase).

The poll also asked medical group leaders their biggest challenge with appointments. Availability/wait times was the top answer (46%), followed by no-shows (38%), cancellations (11%) and "other" (5%). The poll had 505 applicable responses.

Among those answering "other," the most frequent responses included having appropriate staffing levels to handle rising patient demand for care, patients who deferred care during the pandemic presenting large lists of concerns that can't be addressed in the allotted time or during a well visit. providers being unwilling to open blocks on their schedule, limited waiting room space due to COVID-19 guidelines (and patients unhappy about waiting in their cars outside), a lack of accurate clinic grids for scheduling, and higher rates of last-minute cancellations, even in practices that charge fees for them.

THE LARGER TREND

An August 2 MGMA Stat poll found that about half (49%) of medical groups reported their patient no-show rates increased since 2021, compared to about 4 in 10 (39%) that said the rate stayed about the same, and 12% that reported a decrease in the no-show rate.

For medical groups that have seen no-show rates increase or stay the same, the top drivers cited were patients hesitant to seek care due to cost, patients going elsewhere due to long wait times after scheduling an available appointment, lack of transportation to appointments and patient forgetfulness or apathy.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com