CMS has released a report detailing implementation of the value-based payment modifier (VBPM), which was created by the Affordable Care Act, and of the five specialties highlighted as having the largest share of physicians that earned a positive payment adjustment in 2015, gastroenterology led the way.
Within gastroenterology, more than 4,000 physicians were in groups that were subject to the VBPM in 2013, and 5.5 percent of those gastroenterologists were in groups that received a positive payment adjustment in 2015 (for services rendered in 2013). Gastroenterology was followed by dermatology, endocrinology, obstetrics/gynecology, and physical medicine and rehabilitation.
This is the first year that payment adjustments were applied based on cost and quality standards. Only physicians practicing in groups with more than 100 eligible professionals (EPs) were required to submit data for the 2013 calendar year.
Beginning on Jan. 1, 2016, the VBPM payment adjustments will expand to include groups of physicians with 10 or more EPs based on data submitted for the 2014 calendar year. In 2017, the program expands to include all physicians, regardless of group size.
All physicians and physician groups need to register and submit data to CMS using the Physician Quality Reporting System (PQRS) beginning in 2015 to avoid an automatic downward payment adjustment in 2017.
How GIs can participate
Gastroenterologists can use the AGA Digestive Health Recognition Program™ (DHRP) to submit PQRS data to CMS. DHRP is a quality improvement program and clinical data registry that allows clinicians to demonstrate and be recognized for superior quality of care in colorectal cancer screening and surveillance and in the treatment of hepatitis C virus and IBD.
What is the VBPM?
The VBPM program “provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished compared to the cost of care during a performance period.” The VBPM is “an adjustment made on a per claim basis to Medicare payments for items and services under the Medicare PFS.”
More from the 2015 VBPM Report
According to the 2015 Value-Based Payment Modifier Program Experience Report, there were a total of 1,010 physician groups that were within the scope of the VBPM for the 2013 calendar year, but only 14 groups will receive a positive payment adjustment in 2015. Of the remaining groups, 666 will have no payment adjustment in 2015 and 330 will have downward payment adjustments. Of note, only 11 of the 330 groups are receiving a downward payment adjustment based on poor performance in the quality program; the remaining groups either did not register for PQRS or did not meet minimum reporting requirements. Only 106 of 1,010 VBPM eligible groups chose to participate in the quality-tiering program.
How did you perform?
VPBM performance data can be accessed by obtaining and reviewing your Quality and Resource Use Report, which contains information such as the number of Medicare beneficiaries treated, per-patient costs and admissions. Additional information on the VBPM and PQRS and available on the CMS Value-Based Payment Modifier website, which you can access by visiting CMS.gov and selecting “Medicare”.
