CMS has announced the 2015 results of the value-based payment modifier, one of the strategies CMS is using to tie 85 percent of Medicare payments to quality by 2016.
For 2015, only physicians in practices of 100 or more health professionals who submit claims to Medicare, including physicians, nurses and other clinicians, had the option to participate in the program, which calculates upward, downward or neutral Medicare payment adjustments based on 2013 quality performance. CMS plans to expand the program to groups of 10 or more health professionals in 2016 and to all remaining Medicare physicians in 2017.
A total of 1,010 groups of 100 or more professionals were evaluated this year, while 268 large medical groups who participated in other CMS initiatives in 2013 — such as the Shared Savings Program, the Pioneer program or the Comprehensive Primary Care Initiative — were exempt.
Of the 1,010 groups, 691 met the minimum reporting requirements and 127 elected to have their value-based modifier calculated with CMS' quality-tiering methodology.
Of these groups, just 14 are eligible for a positive payment adjustment of approximately 5 percent, 11 will have a downward adjustment of -0.5 or -1 percent, and 81 will have no payment adjustments. Twenty-one groups had insufficient data and will receive a neutral adjustment.
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