Annals of Health Law
READY OR NOT
VBP, this reality is not significantly altered for physicians; under hospital
VBP, physicians are not directly impacted by financial penalties (negative
reimbursement adjustments) levied against the care institutions where they
Misaligned hospital/physician interests threaten to limit performance
achievements under the VBP program. In particular, typical
hospital/physician relations228 do not encourage optimal levels of care
coordination.229 The quality and efficiency of care is often compromised
when splintered across multiple provider locations and certainly it is more
difficult to improve performance scores.230 Moreover, in a fragmented care
setting, both provider and physicians have limited tools to positively
influence one another’s practice patterns to achieve superior patient
outcomes.231 For Hospital VBP especially, hospitals will need to enlist
physician support to meet quality targets and earn the VBP incentive
Hospital administrations’ success in influencing physician behavior can
largely depend on the physician compensation models in place.233
Motivating physicians to improve care delivery is most difficult when the
physicians are members of an independent medical staff and otherwise not
227. See id. It is noted that for physicians participating in physician P4R or P4P they are
incentivized to improve their own record of care delivery. See supra note Section I.
Consequently, physicians should become increasingly interested in improving quality
outcomes as the physician VBP program is implemented in 2015. Moreover, some of the
quality measures in the physician and hospital program overlap or align such that improved
physician quality of care would positively impact both the physician and the hospital.
However, there remain gaps as between and among the physician and hospital quality
measures, as well as a temporal gap between implementation of their respective VBP
programs. See id.
228. See AM. HOSP. ASSOC., TRENDWATCH: CLINICAL INTEGRATION- THE KEY TO
REAL REFORM 1 (Feb. 2010), available at http://www.aha.org/research/reports/tw/10feb-
clinicinteg.pdf (explaining that in the common model physicians use hospital facilities and
rely on hospital staff to provide their services but the medical staff is not employed by the
229. See Anderson & Wilson, supra note 45, at 30.
230. See AHA, supra note 228, at 1-2. Multiple studies show the fragmentation of care
problem . A New England Journal of Medicine study concludes that the typical patient with
multiple chronic conditions sees as many as three primary care physicians and eight
specialists in seven care settings. A Robert Wood Johnson Foundation study reportedly
found that for every 100 Medicare patients treated, each primary care physician would
typically have to communicate with ninety-nine physicians in fifty-three practices in order to
coordinate that patient’s care. See id. at 1-2.
231. See id. at 2.
232. See Anderson & Nedza, supra note 8, at 60.
233. See generally BOLSTERING CHANGE, supra note 225 (discussing generally how
compensation models respond to various payment systems).