Physician Practice

Medicare reports on 2016 physician value modifier

Physician Practice Insider, August 9, 2016

The value modifier (VM) is Medicare’s physician pay-for-performance program that rewards or penalizes physicians for the quality and cost of care they provide. For calendar year 2015, Medicare began applying the VM to professional fees paid under its Professional Fee Schedule for physicians in groups of 100 or more providers.

That year, 14 of 106 groups received an upward adjustment of 4.89% to their fees, and 11 groups were penalized with a 0.5%–1% downward adjustment. The 319 groups who did not report quality measures to Medicare were penalized 2.5%.

For 2016, 13,813 physician groups of 10 or more were subject to the VM. Of these, 5,418 groups were penalized the maximum downward adjustment of 4% in their fee schedule because they did not participate in Medicare’s Physician Quality Reporting System (PQRS). Of the remaining 8,395 groups that did report to PQRS, 70 received an upward adjustment of 16% and 58 received a 32% increase. No group qualified for the maximum possible upward adjustment of 48%. There were 59 groups penalized with a downward adjustment in their fees of 1%–2%.

The VM adjustment employs a two-year look-back period, so performance in 2014 determined the VM for 2016. Medicare will apply the VM in 2017 to all physicians in solo or group practice. Similarly, performance in 2015 will determine the 2017 VM, and performance in 2016 will determine the 2018 VM; that means this year, 2016, is the year for immediate action.

This article originally appeared in CDI Journal. Free registration is required to read the complete article. Click here to register for free and then read the article. Members can access the complete article here.

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