The Value Based Payment Modifier: How will it affect your office this year?

Wednesday, May 27, 2015

The Value Based Payment Modifier (VBPM) program evaluates the quality and the cost of care provided by physicians participating in the Medicare Shared Savings Plan.


Physicians are scored on the quality of care provided to Medicare beneficiaries based on their reported PQRS measures, CG-CAHPS survey if applicable, and hospital based quality metrics. The cost score is determined by each attributed beneficiary’s costs incurred prior to and during an admission to the hospital and up to 30 days after the beneficiary is discharged. These two scores are combined to calculate a Value Modifier score with is then compared to physician scores nationally and ranked via a process called Quality Tiering. Depending on how the physician compares to the national average, the physician may receive a positive, neutral or negative payment adjustment on all Medicare Part B reimbursement two years after the reporting year.

Payment Adjustments

The VBPM program has been phased in by group size. In 2013, only groups of 100 or more providers were affected. These groups are seeing their VBPM payment adjustments now in 2015. In 2014, group of 10 or more were introduced to VBPM. These groups will see their VBPM adjustments in 2016. The VBPM program includes all group sizes and solo physicians in 2015 and they will see their payment adjustments in 2017.

The payment adjustments vary by group size. Larger groups of 10 or more providers are eligible to receive a positive adjustment of up to 4.0x (x = CMS adjustment factor) if they are found to have high quality at low cost compared to their peers nationally. However, if they are found to have lower quality at a higher cost, they are vulnerable to a negative payment adjustment of up to -4%. Smaller group of 2-9 providers and solo physicians can receive a positive payment adjustment of up to 2.0x. Since this is this group’s first year of being included in the VBPM program, they are exempt from a negative adjustment in 2017. It is important to note that the VBPM program also includes an automatic -2% payment adjustment for failure to successfully report PQRS. VBPM payment adjustments are in addition to the -2% PQRS penalty for failure to report or unsuccessful reporting.

Mid-Year Quality and Resource Use Reports (MYQRURs)

CMS has released the 2014 Mid-Year Quality and Resource Use Reports (MYQRURs) to physician solo practitioners and groups of physicians nationwide, including solo practitioners and groups with physicians who participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) model, or the Comprehensive Primary Care (CPC) initiative in 2014. The 2014 MYQRURs  were made available for informational purposes and contain information on a subset of the measures used to calculate the 2016 Value Modifier. The performance period for the MYQRURs is July 1, 2013 through June 30, 2014, and that had a least one eligible case for one of more of the quality or cost measures. If you would like to find out how to access your QRUR, join PHA on June 10, 2015,  to learn about how to access your report, and an get a basic overview of reading/interpreting the data included within the QRURs.

Now is the time to act! If you have any questions about PQRS or the VBPM programs or are interested in assistance with reporting, please contact PHA Managing Advisor Tara Hatfield at PHA at 812-525-0023.

Writer: Tara Hatfield, 812-525-0023,

Tags: Quality Services

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