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An Overview of Value-Based Modifiers

Greenway Health
Greenway Health

The document provides an overview of value-based modifiers as established under the Affordable Care Act. It discusses how value-based modifiers will link physician reimbursement to performance on quality and cost measures. CMS will use existing quality reporting programs like PQRS and meaningful use along with claims-based cost measures to determine value modifiers that may increase or decrease physician payments starting in 2015. The goal is to drive higher value care through linking performance and reimbursement.

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An Overview of Value-Based Modifiers
An Overview of Value-Based Modifiers Affordable Care Act of 2010 (ACA) CMS must bring eRx, PQRS and MU into alignment CMS to establish a payment modifier for differential Physician payments Remember Pay for Higher Value Value = Factor (Quality, Efficiency)
An Overview of Value-Based Modifiers ACA Three Health IT Themes 1. Enhance Quality Reporting and Measurement Needed for Reimbursement Reform Expand Quality Reporting (PQRS, ACO Performance Measures, etc.) Improve Quality of Care (Evidence-Based Guidelines, CDS) Encourage Quality through Reimbursement Modeling (CMMI) 2. Establish Uniform Operating Rules and Standards 3. Promote Health IT Workforce Development
An Overview of Value-Based Modifiers Driving the linkage between performance and reimbursement.
An Overview of Value-Based Modifiers Builds upon Pilot started 2009 Resource Use Reporting to MDs Feedback Reports Added claims-based quality measures Resource Use will determine Value Modifier
An Overview of Value-Based Modifiers CMS Budget neutral Some will get carrots, others will get sticks PROGRAM 2012 2013 2014 2015 2016 2017 Carrots Carrots / Sticks CMS Value-Based +/- +/- +/- Modifiers None None None TBD TBD TBD
An Overview of Value-Based Modifiers Two established Federal Quality Measure Programs PQRS Performance on Core Measure Set Meaningful Use EHR Incentive Program Measures
An Overview of Value-Based Modifiers CMS Final Rule Performance Resource Measures (11.28.2011) o VBM composite of Quality and Costs o Quality: PQRS and MU used to create 62 preliminary VBM measures for P4P o Costs: Total per capita costs for target populations COPD, Heart Failure, CAD, and Diabetes

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An Overview of Value-Based Modifiers

  • 2. An Overview of Value-Based Modifiers Affordable Care Act of 2010 (ACA) CMS must bring eRx, PQRS and MU into alignment CMS to establish a payment modifier for differential Physician payments Remember Pay for Higher Value Value = Factor (Quality, Efficiency)
  • 3. An Overview of Value-Based Modifiers ACA Three Health IT Themes 1. Enhance Quality Reporting and Measurement Needed for Reimbursement Reform Expand Quality Reporting (PQRS, ACO Performance Measures, etc.) Improve Quality of Care (Evidence-Based Guidelines, CDS) Encourage Quality through Reimbursement Modeling (CMMI) 2. Establish Uniform Operating Rules and Standards 3. Promote Health IT Workforce Development
  • 4. An Overview of Value-Based Modifiers Driving the linkage between performance and reimbursement.
  • 5. An Overview of Value-Based Modifiers Builds upon Pilot started 2009 Resource Use Reporting to MDs Feedback Reports Added claims-based quality measures Resource Use will determine Value Modifier
  • 6. An Overview of Value-Based Modifiers CMS Budget neutral Some will get carrots, others will get sticks PROGRAM 2012 2013 2014 2015 2016 2017 Carrots Carrots / Sticks CMS Value-Based +/- +/- +/- Modifiers None None None TBD TBD TBD
  • 7. An Overview of Value-Based Modifiers Two established Federal Quality Measure Programs PQRS Performance on Core Measure Set Meaningful Use EHR Incentive Program Measures
  • 8. An Overview of Value-Based Modifiers CMS Final Rule Performance Resource Measures (11.28.2011) o VBM composite of Quality and Costs o Quality: PQRS and MU used to create 62 preliminary VBM measures for P4P o Costs: Total per capita costs for target populations COPD, Heart Failure, CAD, and Diabetes