2013 Physician Fee Schedule Rule Changes to Value Based Payment Modifier

The Centers for Medicare and Medicaid Services (CMS) final rule on the 2013 Medicare Physician Fee Schedule included modifications to its original proposal on how to begin implementation of the Value Based Payment Modifier (VBM).

The final rule announced CMS' intention to implement a Value Based Payment Modifier using a quality and cost tiering system to groups of 100 or more eligible professionals (as defined by the Medicare-enrolled taxpayer identification number or TIN).  This differs from CMS’ original proposal to apply the payment adjustment to groups of 25 or more eligible professionals.  Successful Physician Quality and Reporting System (PQRS) reporting at the group level will determine a positive or negative payment adjustment.  In 2017, the VBM will apply to all physicians except those participating in Accountable Care Organizations (ACOs), Pioneers, or other initiatives from the Center for Medicare and Medicaid Innovation (CMMI). 

CMS maintained the PQRS reporting will be through the Group Practice Reporting Option (GPRO) or Administrative Claims option and further indicated they will provide flexibility to groups about which quality measures to report.  CMS’ plans to add more specialty-related measures come in direct response to ASA’s official comments, which noted that the GPRO and Administrative Claims "options are specific to measures and metrics for chronic disease and preventative care;  these measures are not germane to non-primary care, single specialty large groups like some anesthesiology groups." 

ASA is closely reviewing the entire 1,362 page final rule.