Value-based Payment Modifier Initiative Winds Down

CMS Releases 2018 Results

January 23, 2018 12:15 pm News Staff

CMS recently released outcomes data on the value-based payment modifier(www.cms.gov) for 2018 -- the final year for the initiative -- and noted some high points.  

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For instance, more than 20,000 physicians and other clinicians will receive increases in their Medicare payments based on quality and cost measures data reported in 2016.

That means CMS will make good on pay increases that range from 6.6 percent to 19.9 percent.

Physicians and other clinicians who met the minimum quality reporting requirements will see positive or neutral payment adjustments; those who did not meet minimum requirements will see their Medicare payment decreased.

Based on details made public in CMS' Jan. 12 fact sheet,(www.cms.gov) the percentage of physicians who will receive a negative payment adjustment in 2018 decreased compared with percentages for the past two years.

Furthermore, CMS noted that because of rule changes in the 2018 Medicare physician fee schedule, practices that reported quality data that would have landed them a penalty based on previous value modifier policies would instead be held harmless.

As noted by CMS, in 2018

  • 3,478 total practices (1.7 percent) representing 20,48l total clinicians will receive an upward payment adjustment,
  • 74,024 practices (35.7 percent) representing 746,556 clinicians can plan on a neutral payment adjustment based on their performance,
  • 8,007 practices (3.9 percent) representing 87,841 clinicians were held harmless and will see a neutral payment adjustment, and
  • 121,642 practices (58.7 percent) representing 296,475 clinicians will get a downward adjustment in their Medicare payment because they failed to report quality measures.

The percentage of the negative adjustment is based on practice size. Solo physicians and those in practices with nine or fewer clinicians will see a 1 percent penalty, and physicians in groups with 10 or more clinicians will receive a 2 percent penalty.

A total of 207,151 practices were included in the 2018 value modifier program, accounting for 1,151,353 total clinicians.

Moving forward, physicians will participate in the Quality Payment Program, which rewards value and outcomes via two pathways -- the Merit-based Incentive Payment System (which effectively replaces the value-based modifier) and advanced alternative payment models.

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Additional Resources
CMS: 2016 Quality and Resource Use Report and 2018 Value Modifier(www.cms.gov)

CMS: Value-based Payment Modifier 2018 X-Factor Calculation(www.cms.gov)