CMS: rate of physicians receiving Value Modifier penalties falls in final year

The Centers for Medicare & Medicaid Services (CMS) has released the results of its 2018 Value Modifier (VM) program, and a smaller percentage of eligible physicians will receive a negative payment adjustment than in the past two years.

Payment adjustments for the 2018 VM are based on performance on care quality and cost in 2016. Physicians who successfully reported to the Physician Quality Reporting System (PQRS) will receive either a positive or neutral payment adjustment. Physicians who failed to successfully report to the PQRS will receive a negative payment adjustment.

Physicians can review their performance by downloading their Quality and Resource Use Report (QRUR). By the way, this is the final year of the VM program. Beginning in 2017, the PQRS and VM programs were consolidated into the Quality Payment Program (QPP).

Almost 26 percent of eligible clinicians, or 296,475, failed to successfully report and will face a negative payment adjustment. Solo physicians and those in groups of up to nine clinicians will receive a 1 percent penalty, while groups with 10 or more will receive a 2 percent penalty. By comparison, 33 percent of eligible clinicians received a negative payment adjustment last year for failing to report and almost 28 percent failed the year before that.

Another 7.6 percent of eligible clinicians would have faced a negative payment adjustment this year for not meeting quality standards. But policy changes under the 2018 Medicare Physician Fee Schedule Final Rule meant those clinicians were “held harmless” if they met minimum reporting standards and will see no change.

About 65 percent of eligible clinicians will also see a neutral payment adjustment this year for meeting the average standards.

More than 20,000 physicians, or a little less than 2 percent of those eligible, will receive a positive payment adjustment. Depending on how well they performed, these physicians will receive an increase of either 1.0x percent or 2.0x percent, where “x” is the 2018 VM adjustment factor of 6.6 percent. An additional 1x percent adjustment is applied to physicians and groups who provided care to complex patients. This means physicians could see an increase of between 6.6 percent and 19.8 percent to their Medicare physician fee schedule payments in 2018.

You can learn more about the QPP reporting requirements on the AAFP MACRA Ready page.

– Erin Solis, regulatory compliance strategist for the American Academy of Family Physicians