March 09, 2016
CMS Publishes Results from Second Year Implementation of Value-Based Payment Modifier
This week, the Centers for Medicare & Medicaid Services (CMS) published results from the second year of the Value-Based Payment Modifier (VM). The VM rewards eligible professionals (EPs) who provide high quality and cost-effective care, while encouraging those who do not to improve their performance. The 2016 VM was applied to groups with 10 or more EPs based on the quality and cost of care provided to Medicare beneficiaries in 2014.
Over 13,000 physician group practices were subjected to the 2016 VM. Physicians in 128 groups will receive an increase in their 2016 Medicare payments. In contrast, physicians in 59 groups will see a decrease in their Medicare payments in 2016 based on their performance in 2014. Also, physicians in 5,418 groups that failed to meet minimum reporting requirements will see a decrease in their Medicare payments in 2016. Medicare payments for most physician groups nationwide (8,208 groups) that met the minimum reporting requirements will remain unchanged in 2016 because of their performance on quality and cost efficiency measures or because there was insufficient data to calculate the groups’ Value Modifier.
• 128 groups will receive an upward adjustment of either “+15.92%” or “+31.84%”;
• 59 groups will receive a downward adjustment of “-1.0%” or “-2.0%”; and
• 8,208 groups will receive a neutral (meaning no) adjustment.
In 2017, Medicare will apply the VM to physician payments under the Medicare PFS for physician solo practitioners and physicians in groups of 2 or more EPs. This policy will complete the phase-in of the Value Modifier to all physicians and groups of physicians as required by the Affordable Care Act. Additional information on can be found on the CMS Value-Based Payment Modifier website.
For additional information, please contact the ASA Department of Quality and Regulatory Affairs (QRA) at [email protected] or 202-289-2222.