What Is the Value-Based Payment Modifier?
The Value-Based Payment Modifier (VM) program assesses both the quality and the cost of care under the Medicare Physician Fee Schedule. The first payment year of the VM was 2015 based on 2013 performance for groups of 100+ eligible professionals (EPs), and the final payment year will be 2018 based on 2016 performance. Starting in 2017, the VM program has been sunset and rolled into the Merit-based Incentive Payment System (MIPS) under the "Quality" and "Cost" categories.
Will You Be Rewarded With Increased Payments?
CMS posted results from the implementation of the fourth year of the VM program. In this report the payment adjustment factor has been determined and will affect 2018 claim amounts. Radiologists are encouraged to view the 2016 QRUR report to find information about their quality and cost performance. View more details here »
The VM and the PQRS programs are aligned. All physicians are evaluated on quality measures submitted through PQRS. The VM uses PQRS quality data and Medicare cost data to determine a provider's overall value score, rewarding high-performing providers with increased payments and penalizing low-performing providers with reduced payments.
Physicians who do not report quality measures through the PQRS program will be subject to automatic payment reductions under the VM.
Three sets of costs are assessed:
Note: The MSPB measure is the only cost measure that may be attributable to radiology groups. This cost measure is included in the 2016 VM and is based on the group’s 2014 services. An explanation of this measure can be found in the 2014 Quality and Resource Use Report.
Quality-tiering will determine if a group’s performance is statistically better, the same or worse than the national mean based on standard deviation calculations.
Value Modifier Penalty for 2015 and 2016 PQRS Non-Reporters
Mandatory Quality-Tiering and Possible 2017/2018 VM Payment Adjustment for Successful 2015/2016 PQRS Reporters
Using quality and cost composite scores, a group will be assigned one of nine possible ratings:
The VM amount practices receive in 2017/2018 based on their 2015/2016 data will differ based on practice size. See summary chart »
For Groups Using the Group Practice Reporting Option (GPRO) in 2016
In order to earn an upward or neutral payment adjustment based on performance and avoid the automatic downward Value Modifier payment adjustment in 2018, EPs in the PQRS Group Practice Reporting Option (GPRO) in 2016 must avoid the 2018 PQRS negative payment adjustment