A Little More on the Physician Value Based Modifier

News Update:  On August 1, 2012 CMS held a national provider call designed to help health care professionals understand how they plan to implement its new value-based payment modifier initiative!

This will become a reality for physicians starting in 2013. Those provider groups with 25 or more eligible professionals will see a -1.0% downward adjustment if they are not satisfactory PQRI reporters. It is anticipated that the value based modifier policies will be finalized by November 2012. Medicare then proposes to apply the value modifier in 2015 completely phasing in the program by 2015.

So how can you avoid penalties?  “Physicians who successfully report for PQRS in 2013 will be shielded from the assessment of penalties in 2015 related to PQRS and to the value-based payment modifier.”

What do eligible providers need to do?

Per CMS:

Participate in PQRS

•Self-nominate as a group in the PQRS Group Practice Reporting Option (GPRO)

•Select one of five PQRS GPRO reporting methods

•Satisfactorily report the required number of measures for the required number of beneficiaries

Decide Whether to Choose the Quality Tiering Approach to Calculate the VM

•Determine whether your group provides care that is high quality/low cost or low quality/high cost

Changes are definitely coming. Again we ask, are you ready?