At a recent AcademyHealth presentation, Cheryl Damberg discussed her research to design a P4P program for implementation for Integrated Healthcare Association (IHA). One thing I noticed about the presentation was that smaller provider groups had patients with lower risk scores (i.e., healthier patients). Is it really the case that small providers treat much healthier patients?
My guess is the answer is not. An alternative explanation would be that small providers do not have as much time or administrative staff to help them code the patient’s comorbidities in their claims (or even EMR). If this is the case, it would make it appear that small provider’s patients are healthier when in fact the true differences may be due to differences in the quality of the data the providers report.
Any VBP system would need to take into account these differences when evaluating providers. Setting a lower standard for small providers, however, would provide a disincentive for small providers to expand into the large provider category, even if this expansion could (potentially) create economies of scale and improve patient care.