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The CMS Value-Based Modifier Program Infographic by HealthFusion

What is CMS’ Value-Based Modifier Program and How Will It Affect Your Practice?

What is CMS’ Value-Based<br />
Modifier Program and How Will It Affect Your Practice?


What is CMS’ Value-Based Modifier Program and How Will It Affect Your Practice?

The CMS Value-Based Modifier program (VBM) is designed to assess both quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule. Starting in 2015, all providers who participate in Fee-For-Service Medicare need to prepare for VBM because their 2017 Medicare payments will be adjusted based on their 2015 performance.

How is the Value-Based Modifier Calculated?

The quality composite score will be calculated based on measures reported through PQRS. This “Quality Tiering” will determine if performance is statistically better, the
same, or worse than the national mean in order to reward or penalize a group based on quality and cost.

How Will Your Practice Measure Up?

You can review CMS’ Quality Resource and Use Reports (QRURs) that provide information about a practice’s quality and performance rates for the VBM. 2012 data is available, and 2013 should be available soon.

What You Need to Do

If you haven’t already, make sure your practice data is correct on PECOS (Medicare Provider Enrollment, Chain, and Ownership System). This is where CMS will gather data for the VBM and the Physician Feedback Reports. Not reporting successfully for PQRS in 2015 will result in an automatic payment reduction of 4% under the VBM program. The good news: Groups with 2-9 providers and solo
practitioners that DO report successfully for PQRS receive only the upward or neutral value-based adjustment for 2017—no downward adjustment. Clearly, the 4% penalty for non participation in PQRS is the most onerous part of the program. That’s why our team at MediTouch has worked so hard to make it easy for you to create compliant reports for PQRS. With MediTouch, it’s easy to evaluate your performance—we make it easy to understand how many patients are in the numerator for each measure, with drill down capabilities to help you understand why particular patients pass or fail for PQRS or Meaningful Use.

Additional References