The Value Modifier measures eligible professionals on quality and cost of care performance. The 2018 Value Modifier will be applied to solo practitioners, physician assistants, nurse practitioners, certified nurse specialists and certified registered nurse anesthetists in groups with two or more eligible professionals, based on 2016 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.
The “2014 Reporting Experience” from CMS summarizes the PQRS data reported in 2014 by eligible professionals, including results specific to cardiology. See how your 2016 performance will impact your 2018 Value Modifier:
Additional +1.0x if average beneficiary risk score is in top 25% of all beneficiary risk scores. Bonuses are calculated based on a budget neutrality adjustment factor (x). In 2016, the adjustment factor is 15.92%.
The 2016 Value-based Payment Modifier results, based on 2014 performance data, have been posted on the CMS website. See a summary of the results: