Medicare Value-Based Payment Modifier Program Ramps Up
April 4, 2014
March 23 marked the three-year anniversary of the passage of the Affordable Care Act (ACA). The law requires that a value-based payment modifier (VBM) be used to direct Medicare dollars to physicians who provide higher quality health care at a lower cost. Those physicians who provided better quality than average will receive an increase, while those who provided average care will not have a change in their payments. Physicians who provided lower-quality care at higher costs will have their Medicare payments decreased.
Starting in 2015, medical groups of 100 or more eligible professionals (EPs) will have their Medicare payments adjusted for the quality and cost of care they provided in 2013. In 2016, the VBM will apply to groups of 10 or more EPs based on 2014 performance information; in 2017, it will apply to nearly all physicians based on their 2015 performance.
The Centers for Medicare & Medicaid Services (CMS) is using data from its Physician Feedback Reports, also known as Quality and Resource Use Reports (QRURs), to help educate physicians about how the VBM could affect their payment under the Medicare Physician Fee Schedule. CMS made the QRURs available to approximately 3,876 physician groups of 100 or more EPs. The reports from 2013 indicated that 80% of medical groups provided average-quality care at average cost. These practices will not be subject to a payment adjustment in 2015. About 8% of groups will receive an increase in payment and approximately 11% will receive a downward adjustment in their payment. Among those eligible for an upward adjustment, 11% of physicians will receive an additional 1% incentive payment for treating high-risk Medicare beneficiaries.