Business Viability Is Healthcare Access: Why VBCA Exists

When Congress passed MACRA in 2015, the premise was reasonable: Medicare would stop paying purely for volume and start paying for the quality and cost of care. A decade later, MIPS, the program that grew out of that law, applies to hundreds of thousands of clinicians. The premise has aged well. How the program lands on independent practices has not.

We have seen it from both sides. Our founding team came up inside large physician enterprises, where we ran ACOs and quality reporting with whole departments of analysts and compliance specialists behind us. MACRA quietly assumes every practice has that kind of support. When we started working with independent practices, we found almost none of it, and yet the quality of their care was rarely what held them back. A solo cardiologist or a small primary care group was often practicing medicine as well as any enterprise down the road. What they were missing was the capacity to keep up with the rules. In an enterprise, that work belongs to a department. In a small practice, it falls to the office manager after the last patient leaves.

We came to think of it as a compliance tax. Every practice pays it, but only large organizations can afford to pay it well, and the way the program is built makes paying it poorly expensive. A practice doesn't learn its score until the summer after the year ends, and any penalty takes effect the following January. As a result, a mistake can sit unnoticed for nearly two years before it reaches the practice's payments, and by then there is nothing left to fix. Meanwhile, the amount at stake keeps growing. Up to 9% of a practice's Medicare Part B payments ride on the result today, and CMS's new mandatory specialty model raises that to 12%.

Every practice pays the compliance tax, but only large organizations can afford to pay it well.

CMS's own numbers show who ends up paying. In the 2025 payment year, 49% of solo clinicians were penalized and 29% took the maximum 9% reduction, compared with 2% of clinicians overall. A gap that wide says far more about staffing than about the quality of care.

It also says something about which practices will still be independent five years from now. For a practice on thin margins, a few years of penalties can decide whether it stays independent. When it sells or closes, the cost doesn't stay with the practice, because the community absorbs it. Patients lose a physician who has known their family for years. The same visit often costs more once a hospital owns the practice. And where doctors are already scarce, a closure means longer waits and longer drives. For a program meant to reward quality, that is exactly the wrong outcome.

That belief is why we founded VBCA in 2020. We set out to keep independent practices viable by giving them the capacity large organizations already have, and because the tools for that didn't exist, we built them. The first was a CMS-approved registry that scores a practice the way CMS will while there is still time to act on the result. That same platform now runs our Medicare ACO, which gives independent practices access to the shared savings large systems have long had. In its first year, the ACO came in $9.3 million under its spending target.

We have kept the work physician-led from the start. Our co-founder, Kristy Reinert, MD, a Clinical Professor of Medicine at the University of Pennsylvania, serves as the ACO's Chief Medical Officer and helped develop the quality measures CMS approved for our registry. The guidance our practices receive comes from a physician who understands those measures because she helped write them.

Six years in, we work with more than 100 practices across 12+ states, and 96% of them stay with us. Our view hasn't changed: a practice's Medicare revenue should reflect the care it delivers, not the size of its compliance staff. Practices that stay viable stay open, and when they stay open, their patients keep their care close to home.

If you run an independent practice and want to know where your MIPS score stands before December 31, talk with us. We'll pull your Medicare numbers before the call.