Value Based Payment Modifier

Value Based Payment Modifier

Determine Your 2017 Value-Based Modifier Payment Adjustment
On September 26, the 2015 Annual Quality and Resource Use Reports (QRURs) were released for review. QRURs demonstrate the performance of physician groups and solo practitioners in 2015 on the quality and cost measures used to calculate the 2017 Value-Based Payment Modifier (VM) payment adjustment. Review today to determine your 2017 VM payment adjustment.

Additional Information

Title: 
What is the Value Based Payment Modifier (VM)?
Body: 

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. To gradually implement the program, the Centers for Medicare & Medicaid Services (CMS) applied the payment modifier to groups of 100 or more eligible professionals (EPs) in 2013, then to groups of 10 or more EPs in 2014. In CY2015, CMS expanded this program to include solo practitioners and groups of 2 or more. In CY2016, CMS will apply the VM (but hold harmless) to non-physician EPs who are PAs, NPs, CNSs, and CRNAs who bill under a group’s TIN or who are solo practitioners. 

Title: 
How is the VM Implemented?
Body: 

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.

Title: 
What Changes are Occurring in 2016 and Will be Applied in 2018?
Body: 

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 +2.0% of MPFS)
Groups with 10+ EPs: 
Upward, neutral, or downward VM adjustment (-4.0% to +4.0% 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/QualityLow QualityAverage QualityHigh 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/QualityLow QualityAverage QualityHigh Quality
Low Cost+0.0%+2.0x**+4.0x**
Average Cost-2.0%+0.0%+2.0x**
High Cost-4.0%-2.0%+0.0%

Please Note:
*Group size includes Physicians, NPs, PAs, CNSs, and CNRAs
**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.