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Medicare's Value-Based Payment Program
The Value-Based Payment (VBP) 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.
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 mandates that CMS begin applying a value-based payment modifier under the physician fee schedule by 2015. In addition, this program must be implemented in a budget neutral manner.
More information on the Value-Based Payment Program:
- Value-Based Payment Modifier Overview
- Understanding Risk Adjustment -
- Keep Hierarchical Condition Categories in Mind When You Code - This blog post explains how hierarchical condition categories (HCCs) and ICD-10 coding will impact payment under value based payment.
- Risk Adjustment Using HCC - CMS Fact Sheet
- ACP Summary of the VBP program from the Medicare Physician Fee Schedule 2014 - Final Rule
- General Overview of the 2016 (performance year 2014) CMS Value-Based Payment Program Presentation
- Linking Performance With Payment - Implementing the Physician Value-Based Payment Modifier. Article from the Journal of the American Medical Association
- ACP Internist Article Value-based payments a new source of reimbursement, penalties March 2013
- Medicare Learning Network - National Provider Calls
- General Overview of the 2015 CMS Value-Based Payment Program Video (8:52)
- CMS 2014 Value Modifier Presentation (January 14, 2014)
- The CMS Value-Based Payment Modifier: What Medicare Eligible Professionals Need to Know in 2014