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This week, the Centers for Medicare & Medicaid Services (CMS) published results from the first year of the Value-Based Payment Modifier (VM). The VM was implemented as part of the Affordable Care Act and assesses the quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule. According to CMS, the VM is one of several tools aimed at shifting the basis for Medicare payments from volume to value. In January, Health & Human Services (HHS) Secretary Sylvia Burwell announced that HHS has set a goal to have 85% of all Medicare fee-for-service payments tied to quality or value by 2016, and 90% by 2018.
Based upon quality data submitted in 2013, the 2015 VM was applied to groups with 100 or more eligible professionals (EPs). The quality-tiering option was a voluntary feature for this first implementation year. Quality-tiering dictates the amount and type of payment adjustment a group may receive (upward, neutral, downward). The groups who did not elect to participate in quality-tiering for 2015 were not subject to upward or downward payment adjustments. Nearly 7,000 physicians in 14 group practices will receive an increase in their 2015 Medicare payments based on their 2013 performances. Eighty-one of the 127 group practices that opted for quality-tiering received a neutral value modifier. Of the remaining, 11 groups received a negative modifier. The CMS analysis of the results can be found here.
In 2016, the quality-tiering mechanism (based in part upon data collected from satisfactorily reporting or participating in 2014 PQRS) will apply to groups with 10 or more EPs who satisfactorily reported or satisfactorily participated in PQRS in 2014. In 2015, the VM will be expanded to more EPs and group practices. Additional information on 2015 PQRS and VM can be found on the ASA PQRS webpage.
For additional information, please contact the ASA Department of Quality and Regulatory Affairs (QRA) at [email protected] or 202-289-2222.
