New data released by Medical Group Management Association (MGMA) shows that revenue from value-based contracts was only 5.5% in surgical specialties, 6.7% in primary care, and 14.7% in nonsurgical specialties. The median revenue from value-based contracts was $30,922 per FTE provider. The data shows that fee-for-service still dominates.
Value-Based Care
NEJM Catalyst defines value-based care (VBC) as “A healthcare delivery model in which providers are paid based on patient health outcomes – providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.”
When VBC programs were expanded as part of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act (MACRA) in 2015, there was hope that the existing fee-for-service model would begin to decline. The new data from MGMA shows that while there has been some movement towards VBC contracts by medical practices, the vast majority are still operating in the fee-for-service model.
In an emailed statement to Healthcare IT Today, MGMA shared that they were surprised at the VBC data. It was their first year of collecting this information and they were unsure where the revenue % would end up. Now having collected a year’s worth of data, MGMA plans to expand their VBC benchmarking in the future.
The VBC data was released as part of MGMA’s Data Report: Patient Access and Value-Based Outcomes Amid The Great Attrition.
Denied Claims Double
That same report showed a 2x increase in the number of claims denied on first submission by medical practices in 2021:
- Primary Care = 8.00% (4.00% in 2020)
- Nonsurgical specialties = 8.14% (3.00% in 2020)
- Surgical specialties = 8.14% (4.16% in 2020)
The report did not give any specific reasons for this significant increase, but one possible reason could be workforce challenges. Since the pandemic started, It has been difficult for practices to keep coders and other HIM staff. Without these experts, the number of denied claims would naturally increase.
In a written comment, MGMA speculated that this increase may also be due to new clinical team members who are not as familiar with the practice’s documentation/coding standards which could lead to denied claims downstream.
Other Data
The report from MGMA also found:
- 49% of medical groups reported an increase in no-show rates since 2021
- 85% of medical groups had the same or higher visit volumes as 2021
- A decrease in the percentage of copayments collected at time of service
- An increase in patient portal usage
- Appointment cancelations holding steady for primary care practices compared to 2020, but increasing for nonsurgical and surgical specialties
“The medical workforce is grappling with burnout, staffing declines, decades-high inflation, operational challenges and a dynamic reimbursement environment that affects providers across the board,” said Dr. Halee Fischer-Wright, MD, MMM, FAAP, FACMPE, president and chief executive officer of MGMA. “This report reveals how addressing scheduling errors and billing denials could help relieve the financial burden on health groups, moving them toward value-based care that promotes the welfare of physicians, staff, and patients.”
You can download the MGMA report here: https://www.mgma.com/data-ops22
