Value-based Modifier (Adjustment)
Is your group comprised of 10 or more providers? If so, your group will be subject to the value modifier in 2016, based on your performance in calendar year 2014. All providers will be subject to the value modifier in 2017 based on their performance in calendar year 2015.
What is the VB Modifier?
Section 3007 of the Affordable Care Act mandated that, by 2015, CMS begin applying a value modifier under the Medicare Physician Fee Schedule (MPFS). It provides for a differential payment (higher or lower) under the MPFS based on the quality of care provided when compared to the cost of the care.
The “quality of care” component is a direct link to the PQRS program. In order to be successful with the VBM and avoid a negative adjustment, physicians and/or groups must report successfully under the PQRS program.
Penalties
Groups that are 10 or more eligible professionals in 2014 that do not successfully report PQRS for 2014 will see a 2% VBM reduction in their 2016 Medicare payments.
According to the CMS website, “Groups of 10 or more EPs can avoid the automatic “-2.0%” Value Modifier payment adjustment in CY 2016 by participating in the PQRS Group Practice Reporting Option (GPRO) in CY 2014 and meets the satisfactory reporting criteria to avoid the “-2.0%” CY 2016 PQRS payment adjustment.” or “Groups with 10 or more EPs can avoid the automatic “-2.0%” Value Modifier payment adjustment in CY 2016, if the EPs in each group participate in the PQRS as individuals in CY 2014 and at least 50% of the EPs in each group meet the satisfactory reporting criteria as individuals (or in lieu of satisfactory reporting, satisfactorily participate in a Qualified Clinical Data Registry) to avoid the “-2.0%” CY 2016 PQRS payment adjustment.”
The VBM program is very complex, especially the calculation associated with the cost measures and the methodology for calculation. Expect more details in the coming months.
Additional information regarding the VBM can be found at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Background.html