Value-Based Payment Modifier Program
CMS proposes a new way to determine the extent of payment cuts and bonuses in the Value-Based Payment Modifier program. The program evaluates the performance of solo practitioners and groups on the quality and cost of care they provide to fee-for-service Medicare patients.
In 2016, the agency proposes to adjust payments based on the size of the participating group and to determine that size by reviewing claims data and its Provider Enrollment, Chain, and Ownership System (PECOS)-generated list. CMS would apply whichever number is lower in PECOS or claims data.
Now is a good time for doctors to check their PECOS data to ensure the information is accurate and up to date, Mr. Shay recommended.
As many expected, the Value-Based Payment Modifier is slowly expanding to encompass more physicians. Beginning Jan. 1, 2015, the value modifier was applied to physician payments under the fee schedule for groups of 100 or more. In January 2016, it will be applied to physician payments for doctors in groups of 10 or more. In 2017, the modifier will apply to solo practitioners and physicians in groups of two or more. (All modifiers are based on performance periods 2 years prior.)
PQRS will continue to play a central role in the Value-Based Payment Modifier system, Mr. Shay added. CMS is proposing to use the PQRS reporting period for 2016 as the basis for the 2018 value modifier. The agency will draw from the group reporting option and individual EP reporting mechanisms proposed for 2016.
“We’re seeing just more interconnection between these two systems,” Mr. Shay said.
Physician Compare
Physicians should expect to have more information about their performance reported to the Physician Compare website under the proposed 2016 fee schedule. The site already continues information on physician education, location, group affiliations, and status in quality programs. CMS now wants to include performance rates on 2015 PQRS cardiovascular disease prevention measures for doctors who report them, in support of the Million Hearts program. Additionally, CMS proposes that groups receiving a pay increase under the Value-Based Payment Modifier Program report the data to the website. Doctors also would continue reporting information about patient experiences under the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey program. The surveys are designed to capture a patient’s experience receiving care from their physician.
Mr. Shay noted that one concern with the Physician Compare website is that doctors have little recourse to challenge information on the site. Physicians have only a 30-day window to review information about themselves and correct errors.
“There is no formal appeals mechanism for the website,” Mr. Shay.
CMS is currently reviewing feedback and comments submitted about the proposed physician fee schedule before issuing the final schedule, usually in November.
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