The Affordable Care Act requires Medicare to phase in a value-based payment (VBP) modifier that would apply to Medicare physician fee-for-service payments starting in 2015, with the VBP modifier applying to all physicians by 2017. The VBP modifier assesses both quality of care and the cost of the care delivered. The payment modifier is based on quality data reported through the Physician Quality Reporting System (PQRS) and cost data analyzed from claims. There are no additional reporting responsibilities for physicians in determining their VBP.
CMS has now made available Quality Resource and Use Reports (QRURs) based on care provided in 2014 to all groups and solo practitioners. The 2014 QRURs display quality and cost composite scores which are used to calculate the VM.
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2015 Value Based Modifier
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Physicians in group practices of 100 or more eligible professionals under a single tax identification number (TIN) based on their performance in CY 2013
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Choose quality tiering and successfully report through PQRS
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+2%, +1% or neutral
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Do not choose quality tiering and successfully report through PQRS
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Neutral
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Do not report through PQRS
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-2%
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2016 Value Based Modifier
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Physicians in group practices of 100 or more eligible professionals under a singletax identification number (TIN) based on their performance in CY 2014
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PQRS reporting reflects quality and cost better than the national mean
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+2% or +1%
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PQRS reporting reflects quality and cost the same as the national mean
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Neutral
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PQRS reporting reflects quality and cost below the national mean
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-2%
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Do not report through PQRS
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-2%
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2016 Value Based Modifier
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Physicians in group practices of 10-99 eligible professionals under a single
tax identification number (TIN) based on their performance in CY 2014
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Successfully report through PQRS
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+2%, +1% or neutral
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Do not report through PQRS
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-2%
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Resources
Physician Value Help Desk
888-734-6433, press option 3
Monday-Friday: 8:00 am - 8:00 pm EST
CMS Value-Based Payment Modifier webpage