Value-based Payment Modifier

What is the Value-based Payment Modifier?

The value-based modifier program will be a budget neutral payment modifier based on relative quality and cost of care. Quality and Resource Use Reports will provide the quality-related feedback. Medicare plans to adjust physician payments using quality data from the Physician Quality Reporting System (PQRS) and cost data from Medicare claims for fee-for-service patients.

According to the Patient Protection and Affordable Care Act, the modifier must be applied to all physicians and physician groups by January 1, 2017.

  • Beginning in 2015 and based on performance in 2013 for groups of 100 or more eligible professionals
  • Beginning in 2017 and based on performance in 2015 for all eligible professionals
  • This is a pay for value (i.e., quality relative to cost) program– higher value gets higher pay; lower value gets lower pay