Value Based Payment Modifier


The Value-Based Payment Modifier (VBPM) program is intended to provide comparative performance information to physicians as part of Medicare’s efforts to improve the quality and efficiency of clinical care. This will be achieved by providing meaningful and actionable information to physicians so they can improve the care they furnish, and by moving toward physician reimbursement that rewards value rather than volume.


A budget-neutral payment system will be implemented to employ a value-based payment modifier to adjust Medicare physician fee schedule payments based on the quality and cost of care being delivered to Medicare beneficiaries. In addition, to ensure that the value modifier encourages physicians to care for the severely ill and beneficiaries with complicated cases, CMS will provide an additional upward payment adjustment for groups of physicians furnishing services to high-risk beneficiaries.


The program contains two primary components:


   •    Quality and Resource Use Reports (QRURs, also known as Physician Feedback Reports)


   •    Development and implementation of the value-based payment modifier (VBPM)


The ACA directs The Centers for Medicare & Medicaid Services (CMS) to provide information to physicians and medical practice groups about their resource use and quality of care provided to their Medicare patients, including quantification and comparisons of patterns of resource use/cost among physicians and medical practice groups.


The ACA requires that CMS begin applying a value-based payment modifier under the physician fee schedule by 2015. In 2015, only physician practices of 100 or more eligible professionals will be affected by the modifier. Although the modifier does not take effect until 2015, it will be based on physician performance data from calendar year (CY) 2013. Beginning in 2017, all physicians are expected to be affected by VBPM.