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 betweenperformance and reimbursement.
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
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
An Overview of Value-Based Modifiers• Two established Federal Quality MeasurePrograms • PQRS – Performance on Core Measure Set • Meaningful Use – EHR Incentive Program Measures
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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