Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

CMS Releases 2016 Value Modifier Results; Bad News for Most Participants


The Centers for Medicare and Medicaid Services (CMS) released the results of the 2016 Value-Based Payment Modifier in early March, and the news is not good for many physician groups around the country.

According to CMS, 13,813 physician group practices with 10 or more eligible professionals are subject to the 2016 Value Modifier based on PQRS reporting and cost performance back in 2014. Only 128 groups exceeded the cost and quality benchmarks to earn a bonus, and they will see a 15.92 or 31.84 percent increase in their 2016 payments based on how high their scores were.

Budget Neutrality

That bonus percentage is so high because so many other physician groups are receiving a negative payment adjustment. Fifty-nine groups had unsatisfactory cost and quality scores and will receive negative payments adjustments of 1 or 2 percent. As well, 5,418 groups failed to meet minimum reporting requirements (like non-participation or unsatisfactory participation in PQRS) and will receive an automatic 2 percent negative adjustment. Because of the budget neutrality of the VBPM program, the more physicians who receive negative adjustments, the higher the positive adjustments are for successful participants.

More than 8,000 eligible physician groups received neither downward or upward payment adjustments because their cost and quality scores were considered average, or because they had insufficient data to calculate cost and quality scores.

In 2017, physicians group practices of all sizes, along with solo practitioners will be evaluated for the Value-Based Payment Modifier.

A Flawed Program?

That fact that fewer than 1 percent of participants earned a bonus is a clear sign that something is wrong with the VBPM program, according to Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association. In an interview with Medscape Medical News, he said, “We knew [the VBM] was flawed, but we could not have predicted how totally flawed it would be in reality. The average physician will look at this and think the game is rigged against them.”

CMS stands behind the program, however, and CMS spokesperson Jibril Boykin pointed the blame at physicians for failing to comply. “The high number of groups receiving downward adjustments comes from their failure to satisfactorily report quality measures as a group or to have at least 50 percent of their eligible professionals in the group satisfactorily report as individuals,” he told Medscape Medical News. “We encourage providers to make sure they are reporting quality measures completely, accurately, and timely during the quality reporting cycle.”

A recent Health Affairs study of MGMA member practices found that physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion on quality measure reporting programs each year. According to the report, most of that time is spent “entering information into the medical record ONLY for the purpose of reporting for quality measures from external entities.” Nearly three-quarters of respondents also said they felt the quality measures they were being evaluated on aren’t clinically relevant.

“As the largest contributor to the problem, the federal government needs to get out of the business of dictating patient care through wasteful mandates and create simplified systems to support medical practices in improving quality across the country,” challenged Halee Fischer-Wright, MD, MMM, FAAP, CMPE, MGMA’s president and CEO.

What Should You Do?

The VBPM program, along with PQRS and the EHR Meaningful Use program, are set to sunset after 2018 (based on the 2016 reporting period). All three programs are being replaced starting in 2019 by the Merit-Based Incentive Payment System (MIPS) created by the Medicare Access and CHIP Reauthorization Act of 2015.

To ensure you receive your full Medicare payments in 2018, however, all eligible providers (which in includes all physicians and most non-physician practitioners) should ensure they are successful participants in the PQRS program to avoid the automatic 2 percent VBPM penalty.

For more information about the 2016 Value-Based Payment Modifier results, review the CMS 2016 VM Overview Memo.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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