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.