CMS reveals results of Value Modifier program's first year

The Center for Medicare & Medicaid Services (CMS) has gotten back the results of the first year of the Value-based Payment Modifier program and recently blogged about them.

The Value Modifier, included in the Affordable Care Act, is intended to encourage physicians and practice groups to provide high quality and cost-effective care. While it will eventually apply to all health care practitioners in the country, the Value Modifier is being phased in gradually and applied only to groups of 100 or more eligible professionals in 2015. Those groups that met at least minimum standards were given the option of electing “quality-tiering,” which boosts, cuts, or leaves stable those physicians’ Medicare payments based on how they performed against national quality and cost benchmarks in 2013. Those who met minimum standards but did not elect quality-tiering – 564 groups – were not subject to any adjustments this year based on their performance.

According to CMS, nearly 7,000 physicians in 14 group practices across the country are receiving an increase in their Medicare payments in 2015 as a result of this quality-tiering. The group practices receiving increases fell into two categories:

1.    Groups that produced high quality care at average cost (the majority of groups receiving increases).
2.    Groups that produced average quality care at lower-than-expected cost.

Physician groups getting increases had, on average, better hospital readmissions rates –14.3 per 100 admissions – than the national benchmark of 16.4. These groups also had, on average, lower hospital admissions rates for acute and chronic ambulatory care sensitive conditions. Another 102 groups electing quality-tiering will see no change either because they met the national benchmarks or there was insufficient data.

Meanwhile, 330 groups are slated to see their Medicare payments cut in 2015 because of the Value Modifier program. Eleven groups subjected themselves to quality-tiering but failed to meet national benchmarks for quality or cost. Another 319 failed to meet the minimum requirements of the program and didn't have an option to elect quality-tiering.

Beginning in 2016, the Value Modifier will apply to groups with at least 10 or more eligible professionals, and quality-tiering will automatically apply to all of them. In 2017, the Value Modifier will apply to all groups and to solo practitioners who are physicians. Beginning in 2018, CMS will apply the Value Modifier to non-physician eligible professionals as well.

Physician groups and physicians can find information about their quality and cost performance in their Quality Resource and Use Reports  that were made available last fall.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted on Mar 12, 2015 by David Twiddy