Despite a predicted continual move away from fee-for-service, value-based care still accounts for a small portion of medical revenue in most specialties, a new report has revealed.
The Medical Group Management Association (MGMA), a trade group focused on medical practice management, put out its latest 2022 DataDive Practice Operations report based on last year’s data from more than 2,300 organizations.
Improving patient access and care delivery are top priorities for healthcare leaders. Though there is little consensus on a definition of value-based care, the report noted, the gradual move away from fee-for-service will continue. Value-based contracts accounted for 7% of medical revenue among primary care specialties, 6% among surgical specialties and 15% among nonsurgical specialties. On average, that represents about $30,922 per provider.
The survey also provided key benchmarks for quality measures. Median quality measure performance across all reporting practices were: 3% hospital admission rate, 11% hospital 30-day readmission rate, 27% emergency department utilization rate and 1% 30-day postoperative infection rate. Nearly half of practices use both in-house analysts and third-party vendors for quality analytics.
Forty-two percent of medical practices tied quality performance metrics to physician compensation plans. That’s up compared to previous years. About 1 in 4 (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%) groups had tied quality performance to physician compensation.
Due to staffing shortages, appointment availability for new patients increased by two days, and, for about half of medical groups, no-show rates increased since 2021. Most medical groups also had visit volumes higher or the same as 2021 levels. To optimize scheduling, the report suggested practices look at the total number of available hours each provider has scheduled to understand the overall hours of provider capacity available.
Patient portal usage improved in 2021 with a 17% increase in patient logins. Among the top reasons patients accessed the portal were to pay bills, communicate with providers and fill a new prescription.
Practices reported it took longer to post charges in 2021 for third-party payment compared to 2020. There was also a spike in how many claims were denied on first submission. Practices reported decreases in how many co-payments were collected at the time of service.
Overall, there was an improvement in the number of patient-due balances collected at time of service. One respondent implemented new billing rules to increase clean claims. Another pointed to renewed enrollment in the Affordable Care Act plans to reduce the number of uninsured patients. Others outsourced elements of revenue cycle management to minimize administrative burden.
The fundamental metrics identified “dictate how patients and staff interact with and perceive your practice,” the report said. “Casting light on these will help improve satisfaction rates all around, which will have positive impacts on revenue, outcomes and more.”