What is the Value-Based Modifier (VBM) and Quality-Tiering?

The Value-Based Modifier will apply to all physicians in 2018.  Non-reporting (of PQRS) in 2016 will automatically result in a -2% VM payment adjustment for groups of 1-9 providers and a -4% adjustment for groups of 10 or more.  This is in addition to the -2% PQRS penalty for not reporting.

The VBM payment adjustment is applied through quality-tiering.  Quality-tiering is the methodology used to evaluate a group or solo practitioner’s performance on quality and cost measures for the Value Modifier.   PQRS quality data and Medicare cost data is used to determine a provider's (or group of providers) overall score.  This system rewards high performance with increased payments and reduces payments to lower scorers.

Groups with 2 or more EPs could receive an upward adjustment (up to 4x the adjustment factor), a (up to 4%) downward adjustment, or no adjustment .  Solo providers could receive an upward adjustment (up to 2x the adjustment factor) or no adjustment.

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