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Value-based Payment Modifier

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Few provider groups benefited from CMS’s value-based payment program


Data from the Centers for Medicare & Medicaid Services show that few provider practices benefited from the agency’s Value-Based Payment Modifier program.

13,813 physician groups were eligible to compete for the pay bump, but only 128 group practices will see their Medicare reimbursement rise by 16 percent or 32 percent, with the higher percentage going to practices with the most high-risk patients.

The fact that so few practices benefit from VBM could indicate an inherent flaw in the program’s methodology, Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, told Modern Healthcare.

“These results show that getting a reimbursement increase is akin to winning the lottery. This just isn’t a meaningful system.”

MIPS looms, but maybe you can opt out


Providers are girding their loins to comply not only  with the next stage of the Meaningful Use program, but also a  new mandated electronic reporting requirement: Medicare’s Merit-based Incentive Payment System (MIPS).

The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use and clinical-practice improvement.

Robert Tennant, senior policy adviser with the Medical Group Management Association (MGMA),  told MedPage Today that the two programs are very inter-twined:
“Even though Meaningful Use was sunsetted, it’s now effectively 25% of your MIPS score, so it never really goes away.” And because it is so much of the MIPS score, “it’s potentially more impactful on your reimbursement.”

But Linda Delo, D.O., a family physician in Port Saint Lucie, Fla., told the online news service that, as MedPage paraphrased her, “{P]hysicians can get out from under MIPS in some cases if they become part of an alternative payment model such as an Accountable Care Organization (ACO), a bundled payment model, or a patient-centered medical home (PCMH), rather than continue in the traditional fee-for-service Medicare program.”


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