Monday, February 8, 2016

Medicare Value-Based Payment Modifier

This might be the way stroke survivors finally get doctors and hospitals to focus on results. Nothing else seems to have worked. Our stroke associations should be working with CMS(Centers for Medicare & Medicaid Services) to ensure that doctors working with survivors are only paid upon providing better results that the current statistics - 10% full recovery, 12% full tPA efficacy.
I don't give a shit about how many doctors don't like payments for results. My doctor should have been paid nothing, he shoved all the responsibility for recovery on the PTs, OTs and STs. My recovery had nothing to do with anything he did.

How Measurement Fails Doctors and Teachers

JAMA Forum: If You Can’t Measure Performance, Can You Improve It?


https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.html#Gradual%20Implementation%20of%20the%20Value%20Modifier

Value-Based Payment Modifier

What is the Value-Modifier
         Fact Sheet for the 2016 Value-Based Payment Modifier
         Fact Sheet for Attribution in the Value-Based Payment Modifier Program
         Fact Sheet for Specialty Adjustment in the Value-Based Payment Modifier Program
         Fact Sheet for Risk Adjustment in the Value-Based Payment Modifier Program
Gradual Implementation of the Value Modifier
Quality and Cost Measures Used in the Value Modifier
        Measure Information Form: Ambulatory Care-Sensitive Condition (ACSC) Composite Measures
        Measure information Form: All Cause Hospital Readmission
        Measure Information Form: Overall Total Per Capita Cost Measure
        Measure Information Form: Condition-Specific Total Per Capita Cost Measures
        Measure Information Form: Medicare Spending Per Beneficiary Measure 
CY 2015 Payment Adjustment – Physician Groups of 100 or more Eligible Professionals
       Summary of 2015 Physician Value-based Payment Modifier Policies
       The 2015 Value Modifier Results
       2015 Value Modifier Program Experience Report
       Quality Benchmarks for the 2015 Value Modifier and the 2013 Quality and Resource Use Reports
CY 2016 Payment Adjustment – Physician Groups of 10 or more Eligible Professionals
        Fact Sheet: Changes for the Physician Value-based Payment Modifier in the CY 2014 Medicare Physician Fee Schedule Final Rule
        Quality Benchmarks for the 2016 Value Modifier and the 2014 Quality and Resource Use Reports (to be released Fall 2015)
CY 2017 Payment Adjustment – Physician Solo Practitioners and Physician Groups of 2 or more Eligible Professionals
CY 2018 Payment Adjustment - Physicians and Non-Physicians Who Are Solo Practitioners or in Groups of 2 or More Eligible Professionals

What is the Value-Based Payment Modifier (Value Modifier)

The Value Modifier provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished compared to the cost of care during a performance period. In the future, the Value Modifier will be used to adjust Medicare PFS payments to non-physician eligible professionals (EPs), in addition to physicians. The Value Modifier is an adjustment made on a per claim basis to Medicare payments for items and services under the Medicare PFS. It is applied at the Taxpayer Identification Number (TIN) level to physicians (and beginning in 2018, to non-physician EPs) billing under the TIN.
Fact Sheet for the 2016 Value-Based Payment Modifier [PDF, 268KB]

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