MPFS: Value Modifier Would Affect Payment

The proposed rule for 2013 Medicare Physician Fee Schedule (MPFS) policies and rates provides detail about the physician value-based payment modifier (value modifier) required under the Affordable Care Act.

The value modifier would adjust payments to individual physicians or groups of physicians based on the quality of care furnished to Medicare beneficiaries as compared to costs. The Centers for Medicare & Medicaid Services (CMS) will phase in the value modifier over three years, from 2015 to 2017.

Under the current proposal, physician groups of 25 or more that do not participate in the Physician Quality Reporting System (PQRS) would be assigned a value modifier leading to a 1.0 percent payment reduction (in addition to the -1.5 adjustment for not participating in the PQRS) beginning in 2015. CMS is seeking comment on whether this should apply to physicians in solo practices or groups with less than 25 eligible providers.

For physician groups with 25 or more eligible professionals that have met satisfactory PQRS reporting criteria, the value modifier would not affect payments (it would be set at 0.0 percent)—unless they choose an option to earn an upward payment adjustment for high performance (“high quality and low cost”). This option would, however, place the group at risk for a payment adjustment for poor performance (“low quality and high cost”), with a maximum downward payment adjustment of -1.0 percent initially.

The proposed rule will be published in the July 30 Federal Register. CMS will accept comments on the proposed rule until Sept. 4. A final rule with comment period will be issued by Nov. 1.

Want to learn more? CMS will be hosting a national provider call Aug. 1 from 2:30 to 4 pm ET for fee-for-service providers regarding the value modifier. Register to attend this free event.

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