CMS Releases 2016 Value Modifier Results

Added on Mar 21, 2016

CMS Releases 2016 Value Modifier Results
From Industry Edge March 2016

The Centers for Medicare & Medicaid Services (CMS) released results from the implementation of the 2016 Value-Based Payment Modifier, which rewards physicians and physician groups that provide high-quality, cost-effective care while encouraging improvement for those who do not report quality measures or who have poor performance.

The 2016 Value Modifier payment amount is based on the 2016 upward payment adjustment factor of +15.92%. According to CMS, 13,813 physician groups (as identified by their Medicare-enrolled Taxpayer Identification Number or TIN) with 10 or more eligible professionals are subject to the Value Modifier in 2016. Out of these, 8,395 TINs met the criteria to avoid the 2016 Physician Quality Reporting System (PQRS) payment adjustment as a group or as individuals, and their 2016 Value Modifier was calculated using the quality-tiering methodology. The results are as follows.

  • 128 groups exceeded the program’s benchmarks in quality and cost efficiency and will receive an upward adjustment of either “+15.92%” or “+31.84%” in their payments under the Medicare Physician Fee Schedule.
  • 59 groups did not perform well, and their physicians will see a “-1.0%” or “-2.0%” downward adjustment in their Medicare payments in 2016.
  • Physicians in 5,418 groups that failed to meet minimum reporting requirements will see a “-2.0%” decrease in their Medicare payments in 2016.
  • Medicare payments for 8,208 physician groups nationwide that met the minimum reporting requirements will receive a neutral (meaning no) adjustment in 2016 because of their performance on quality and cost-efficiency measures or because there was insufficient data to calculate their Value Modifier.

To be eligible for upward adjustments in future years and to avoid the automatic downward adjustment for not meeting minimum reporting requirements, CMS “strongly encourages groups and solo practitioners to report their PQRS quality data to CMS in a manner that ensures that the data submitted are accurate, complete, and timely.”