An increasingly large share of dollars exchanged for health services are tied to performance, a new study finds.

The survey of 86 individuals from health care payers or health care providers by KPMG finds half are involved with reimbursement plans linked to outcomes. 

While 36 percent are reimbursed partially based on their performance on metrics, such as cost and hospital readmission rates, an additional 14 percent say they are reimbursed entirely based on value-based metrics.

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The study shows value-based reimbursement is bound to increase even more in the coming years. A quarter of the organizations say they have plans to be a party to a value-based contract in the next three years, meaning that three-quarters of all of the respondents expect to be playing the value-based game by 2020.

But what about the other quarter of organizations?

"It is not necessarily a surprise that nearly a quarter of providers are not acknowledging the need for value-based payments," says KPMG partner Joe Kuehn in a statement.

"Various parts of the country are transitioning at a slower pace," he adds. "The vast majority of health plans and providers, however are moving this way, particularly after CMS had set some aggressive targets in January 2015, followed by some of the national health plans, to shift their reimbursement in this direction."

Under former President Barack Obama, the Centers for Medicare and Medicaid Services aggressively sought to reduce long-term spending by introducing outcome-based payments to Medicare.

Last year, for instance, Medicare began basing reimbursements to providers for knee and hip replacements based on certain outcomes, such as whether the patient is readmitted to the hospital within 30 days of the operation.

More broadly, 2017 is the first year when Medicare Part B providers will be assessed under the either the Merit-based Incentive Payment Programs (MIPPS), which will begin adjusting reimbursements for providers in 2019 based on their performance on a number of metrics in the preceding years. There is a separate track (Alternative Payment Models) for providers that choose to develop and propose an alternative value-based reimbursement system to be reviewed and potentially authorized by CMS. 

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