Value-based Payment Modifier 2014 Results

On Monday, March 8, CMS published the results of the Value-based Payment Modifier calculations for 2016.  For groups with ten or more eligible professionals in 2014, the results identify the value of any upward adjustment to a group’s Medicare reimbursement for 2016.  It also reveals the number of groups who will see a downward adjustment and the number of groups whose reimbursement will not change.  This program is budget neutral, meaning that the upwards adjustments are calculated based on the value of the downward adjustments.  The report does not provide any breakdown of specialties so we are unable to determine the impact for ophthalmology groups or optometric groups with ten or more eligible professionals in 2014. 

The report indicates that updated payment amounts, both positive and negative, will begin after March 14, 2016.  Prior claims for 2016 will be reprocessed. 

CMS reports that 13,813 physician groups were subject to the Value Modifier.  Of these, 5,418 did not successfully report PQRS in 2014, leaving them with an automatic 2.0% downward Value Modifier payment adjustment. 

Of the remaining 8,395 groups, the results breakdown as follows:

• 97.8% – 8,208 groups will see no change in Medicare reimbursement in 2016
• 0.7% – 59 groups will see a downward adjustment of either 1% or 2%
• 1.5% – 128 groups will see an upward adjustment of either 15.92% or 31.84%

A small number of groups are eligible for an additional 15.92% adjustment for treating high-risk beneficiaries. 

In 2017, the Value-based payment modifier applies to all physicians and is based on their 2015 performance. 

The CMS report can be found at:  https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Overview-PDF-Memo.pdf

For additional information on PQRS and the Value-based Payment Modifier as it relates to ophthalmology and optometry, we recommend our recently updated monograph titled 2016 Physician Quality Reporting System.