Adapting VBC Strategy to Success | Let's Talk Revenue

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Adapting VBC Strategy to Success: Let's Talk Revenue: Turn the Tables on Physician & Quality Pay Cuts

Instead of waiting for Congress to act, Let's Talk Revenue.

I have been thinking about this topic since the election and anticipating change. VBC must pivot and reinvent itself and more importantly take control of their programs.
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This week has been chaotic for value-based care (VBC) for several reasons:

Government shutdown approaches as March 14 deadline looms

? The House of Representatives voted 217-213 to pass a continuing resolution that funds the government until Sept. 30, 2025, and extends expiring Medicare telehealth flexibilities until the same date. The House voted mostly along party lines.
? If a resolution is not passed, we face another potential government shutdown on Friday, March 14, 2025. The Senate still needs to debate and find 60 votes before a federal government shutdown is avoided.

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Physician Pay Cuts

The Medicare physician pay cuts continue with a 2.83% reduction for 2025. Pay cuts at a time when financial and physician shortage concerns are at an all-time high. The "Medicare Patient Access and Practice Stabilization Act" proposed to reverse the cuts is under review, with no definitive action yet.

The Relative Value Units (RVUs) conversion factor has barely increased since 1992. $31.00 to $32.36. RVUs are weights that determine how much a physician is paid for a service. RVUs are used in the Medicare Resource-Based Relative Value Scale (RBRVS).

If RVUs had increased at a normal rate each over the last 33 years (1992 to 2025), that $31 would be $64. (Credit to Dutch Rojas Post)

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Quality Bonus Reductions

For payment year 2025, qualified providers participating in Advanced Alternative Payment Models (AAPMs) will receive a 3.5% lump-sum bonus based on their previous year's Medicare Part B payments, marking a decrease from the 5% previously available.

In 2025, MIPS payment adjustments will range from -9% to approximately +2.15%
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VBC Program Terminations

Center for Medicare and Medicaid Innovation (CMMI) models may cancelled early at end of 2025.
? Making Care Primary (introduced in 2023, 10.5yr model; states participating include Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina, and Washington)
? Primary Care First (started in 2021)
? End Stage Renal Disease Treatment Choices
? Maryland Total Cost of Care Model
? Maternal Opioid Misuse (MOM) Model (1yr before anticipated end)
? Vermont All-Payer ACO Model (1yr before anticipated end)