Value Based Payment Modifier

Value Based Payment Modifier

What is the Value Based Payment Modifier (VM)?

The VM program is intended to assess both quality of care furnished, and the cost of that care, under the Medicare Physician Fee Schedule (MPFS) and pay physicians differentially based on specific program components. In order to gradually implement the program, the Centers for Medicare and Medicaid Services (CMS) is expanding this program in CY2015 to include solo practitioners and groups of 2 or more.

How is the VM Implemented?

Implementation of the VM is based on participation in Physician Quality Reporting System (PQRS). For information on a fast, convenient, and cost effective online registry to help you collect and report quality measure data to CMS for the PQRS incentive program, see information on the PQRSwizard.

What Changes are Occurring in 2015 and Will be Applied in 2017?

For a brief overview of how the VM Payment Adjustments and Quality-Tiering components of the program may affect you, please see below:

VM Payment Adjustments

For PQRS reporters 
Groups with 2-9 EPs and solo practitioners: 
Upward or neutral VM adjustment (+0.0% to +2x of MPFS)
Groups with 10+ EPs: 
Upward, neutral, or downward VM adjustment (-4.0% to +4.0x of MPFS) 

For Non-PQRS reporters 
Groups with 2-9 EPs and solo practitioners: 
Automatic -2.0% of MPFS downward adjustment
Groups with 10+ EPs: 
Automatic -4.0% of MPFS downward adjustment

 

VM Policies for Quality Tiering

CY 2017 VM Amounts for Groups with 2-9 EPs and Solo Practitioners 
Cost/Quality Low Quality Average Quality High Quality
Low Cost +0.0% +1.0x* +2.0x*
Average Cost -0.0% +0.0% +1.0x*
High Cost -0.0% -2.0% +0.0%

  

CY 2017 VM Amounts for Groups with 10 or More EPs 
Cost/Quality Low Quality Average Quality High Quality
Low Cost +0.0% +1.0x* +2.0x*
Average Cost -2.0% +0.0% +2.0x*
High Cost -4.0% -2.0% +0.0%

 

Please Note: Groups and solo practitioners receiving an upward adjustment are eligible for an additional +1.0x if their average beneficiary risk score is in the top 25% of all beneficiary risk scores nationwide.