The Value Modifier measures physicians on quality and cost of care performance. The 2017 Value Modifier will be applied to all physicians, including solo practitioners and small group practices, based on 2015 performance.

The quality component is determined by the physician’s Physician Quality Reporting System (PQRS) participation, plus three outcome measures:

  • 30-day all-cause hospital readmissions
  • Two composite hospital admission measures for acute conditions and chronic conditions.

The cost component is calculated based on six cost measures:

  • Total per capita costs for all attributed beneficiaries
  • Total per capita costs for beneficiaries with specific conditions (diabetes, coronary artery disease, chronic obstructive pulmonary disease, heart failure)
  • Medicare spending per beneficiary

The Centers for Medicare and Medicaid Services (CMS) provides physicians with Mid-Year and Annual Quality and Resource Use Reports (QRURs) to assist them in gauging their performance during the year. QRURs can be accessed through the Enterprise Identity Management System, which has replaced the Individuals Authorized Access to CMS Computer Services system as of July 13, 2015.

See how your 2015 performance will impact your 2017 Value Modifier below:

Value Based Modifier information graphic