Introduction to Value-Based Payment Modifiers

• Published in: Journal of the American College of Radiology Vol. 9; no. 10; pp. 718 - 724
• Main Authors: Becker, Gary J., MD, Bosma, Jennifer L., PhD, Burleson, Judy, MHSA, Borgstede, James P., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2012
• Subjects: Benchmarking; Centers for Medicare and Medicaid Services (U.S.); Certification - standards; CMS; Medicine; physician performance measures; physician reimbursement; Physicians - economics; Physicians - standards; PQRS; Quality Indicators, Health Care; Radiology; Reimbursement, Incentive; United States; Value modifiers; United States; CMS; Value modifiers; physician reimbursement; PQRS; physician performance measures
• ISSN: 1546-1440; 1558-349X
• DOI: 10.1016/j.jacr.2012.06.017

Value-based payment modifiers were legislated by Congress in the 2010 Patient Protection and Affordable Care Act. It is clear in the legislation, and the corresponding proposals published by the secretary of the US Department of Health and Human Services in late 2011, that the intent is to move from paying physicians for reporting to paying physicians for performance. The proposals, developed jointly with CMS, specify that the calculation of payments for performance will be a composite of quality and cost measures. The base year for determining performance benchmarks for the performance measures will be 2013, and the measures will be applied to physician payments on a limited basis beginning in 2015 and to all physician payments by 2017. The role of medical specialty boards, such as the ABR, in the development and deployment of measures is highlighted in this context. CMS's recent conversations with board representatives have indicated their view that the boards' measure development activities are key to increasing physician (especially specialist) participation in the Physician Quality Reporting System to 50% by 2015, from 20% to 30% today. The ABR will continue its past activities in this arena, working with the American Board of Medical Specialties, CMS, and specialty societies, so that ABR diplomates will be able to simultaneously complete their Maintenance of Certification requirements, satisfy the requirements for CMS incentives, and avoid penalties.