CMS Releases 2018 Value-Based Payment Modifier Data; Less than 2 Percent of Clinicians See Positive Adjustment

The Centers for Medicare & Medicaid Services (CMS) released final data on practices and individual clinicians impacted by the 2018 Value-Based Payment Modifier (VM). Such eligible professionals will see a positive, negative or neutral adjustment to their 2018 Medicare Part B Fee-For-Service payments. The payments are based upon whether a practice successfully participated in the Physician Quality Reporting System (PQRS) in 2016 and if they demonstrated high quality and lost cost care based upon 2016 data.

Both PQRS and VM programs were discontinued after performance year 2016/payment year 2018. PQRS and VM were replaced by the Merit-based Incentive Payment System (MIPS) Quality and Cost components respectively, beginning in performance year 2017.

In 2018, nearly 65 percent of eligible professionals will receive a neutral modifier while just 1.8 percent will see positive payment adjustments of between 6.63 percent and 19.88 percent. About 26 percent of eligible professionals did not meet PQRS requirements and automatically incurred a penalty of either 1 or 2 percent on their payments. The remaining eligible professionals, 7.6 percent, were spared that same adjustment because of a rule change, supported by the American Society of Anesthesiologists and other medical specialties, within the 2018 Physician Fee Schedule.

Practices are encouraged to download their Quality and Resource Use Reports to determine how they performed in 2016 and whether they will see a neutral, positive or negative adjustment this year.

For more information, contact the ASA Department of Quality and Regulatory Affairs (QRA) at [email protected].