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Value-Based Modifier

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A field guide to CMS’s value-based modifier


Here’s a guide for physicians on how to deal with CMS’s new value-based modifier.

As Medscape notes: “VBM could increase your income by up to 2% in the first year, or lower your income by 1% in 2015 and 2% in 2016.”

A VBM is  an incentive or a penalty to be applied to  a physician’s Medicare revenue, on the basis of how CMS has judged the quality and efficiency of  patient care.  And, Medscape reports, “under  bipartisan bills introduced in both houses of Congress, ‘value-based payments’ to doctors would entail incentives or penalties of 4% in 2017, rising to 10% in 2020 and possibly to 12% in 2021 and beyond. These amounts would combine the current bonuses and penalties in the VBM, the Physician Quality Reporting System (PQRS), and the meaningful use programs. These carrots and sticks would replace the loathed Sustainable Growth Rate (SGR).”

To read the entire guide, please hit this link.

AMA president says physicians need more payment-system consistency


Steven J. Stack, M.D., says that physicians need  more consistency and predictability in new alternative-payment models.

He made his remarks in a Physicians Practice interview after CMS’s new multi-payer initiative  aimed at improving primary care was announced earlier this week.

The program will give practices an upfront care-management fee that they can  keep if they meet performance-based quality and use-performance thresholds.

Dr. Stack said, among other things:  “There needs to be predictability and stability. We need to not be changing the rules every 12 months to 18 months. You can’t run a business when the payment method is changing year over year. Predictability and stability are important. The other thing is there needs to be candor and transparency.”

“Some of the methodologies for the current programs — the Value-Based Modifier or Meaningful Use — have set physicians up for failure. They are not good methodologies to do some of the things that are required. The likelihood of failure is high. Meaningful Use is an all or none, pass/fail paradigm. You get 100 percent you pass, you get 99.9 percent, you fail. Those kinds of things I think most Americans would feel are unreasonable and not fair.

“CMS has to (design) programs that are reflective of the variation in healthcare that’s appropriate and (accommodate for the fact) there are multiple ways to achieve different outcomes. If CMS can design programs that reflect the variation in physician care and patient needs, and hold physicians accountable for more reasonable deliverables … if that’s able to be done over a period of years, physicians can come to learn to be accepting of CMS and less frustrated by it.”

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