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An Overview ofValue-Based Modifiers
An Overview of         Value-Based Modifiers• Affordable Care Act of 2010 (ACA)  •   CMS must bring eRx, PQRS and MU into ...
An Overview of           Value-Based Modifiers• ACA → Three Health IT Themes  1.   Enhance Quality Reporting and Measureme...
An Overview of  Value-Based Modifiers   Driving the linkage betweenperformance and reimbursement.
An Overview of       Value-Based Modifiers• Builds upon Pilot started 2009 – Resource UseReporting to MDs → Feedback Repor...
An Overview of      Value-Based Modifiers• CMS Budget neutral → Some will getcarrots, others will get sticks     PROGRAM  ...
An Overview of         Value-Based Modifiers• Two established Federal Quality MeasurePrograms  •   PQRS – Performance on C...
An Overview of         Value-Based Modifiers• CMS Final Rule – Performance ResourceMeasures (11.28.2011)  o   VBM → compos...
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An Overview of Value-Based Modifiers

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Transcript of "An Overview of Value-Based Modifiers"

  1. 1. An Overview ofValue-Based Modifiers
  2. 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. 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. 4. An Overview of Value-Based Modifiers Driving the linkage betweenperformance and reimbursement.
  5. 5. An Overview of Value-Based Modifiers• Builds upon Pilot started 2009 – Resource UseReporting to MDs → Feedback Reports• Added claims-based quality measures• Resource Use will determine Value Modifier
  6. 6. An Overview of Value-Based Modifiers• CMS Budget neutral → Some will getcarrots, 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. 7. An Overview of Value-Based Modifiers• Two established Federal Quality MeasurePrograms • PQRS – Performance on Core Measure Set • Meaningful Use – EHR Incentive Program Measures
  8. 8. An Overview of Value-Based Modifiers• CMS Final Rule – Performance ResourceMeasures (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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