The Value-Based Payment Modifier (VBPM) Program adjusts Medicare Physician Fee Schedule (PFS) payments to a physician or group of physicians based on the quality and cost of care furnished to their Medicare Fee-for-Service (FFS) beneficiaries.  (Individual physicians and groups are identified by their Taxpayer Identification Number [TIN]). CMS has aligned the Value Modifier Program’s quality measurement component with the reporting requirements under the Physician Quality Reporting System (PQRS). The VBPM does not require any additional action from eligible professionals other than satisfying PQRS reporting requirements.

As of January 1, 2016, the VBPM is now applied to physician payments under the Medicare PFS for physicians in TINs with 10 or more eligible professionals—provided that at least one physician submitted a Medicare claim during 2014 under the TIN. Calendar Year (CY) 2014 is the performance period for the Value Modifier that will be applied in 2016. In 2016, CMS will not apply the Value Modifier to TINs in which one or more physicians participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care (CPC) initiative during the relevant performance period.

2016 Value Modifier Fact Sheet

 

Low Quality

Average Quality

High Quality

Quality-tiering categories and 2016 payment adjustment for TINs with 10 to 99 eligible professionals

Low Cost

0.0%

+1.0 x AF*

+2.0 x AF*

Average Cost

0.0%

0.0%

+1.0 x AF*

High Cost

0.0%

0.0%

0.0%

*Higher-performing TINs treating high-risk beneficiaries (based on mean CMS-HCC risk scores) will receive an additional adjustment of +1.0 x Adjusting Factor (AF).

 

 

Low Quality

Average Quality

High Quality

Quality-tiering categories and 2016 payment adjustment for TINs with 100 or more eligible professionals

Low Cost

0.0%

+1.0 x AF*

+2.0 x AF*

Average Cost

-1.0%

0.0%

+1.0 x AF*

High Cost

-2.0%

-1.0%

0.0%

References

Fact Sheet for the 2016 Value-Based Payment Modifier [PDF, 268KB] (CMS)