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Medicare FFS Physician Feedback Program/Value-Based Payment Modifier

What?

The Physician Feedback Program provides comparative performance information to physicians and medical practice groups, as part of Medicare’s efforts to improve the quality and efficiency of medical care furnished to Medicare beneficiaries.  Providing clinically meaningful and actionable information to physicians so they can improve the care they deliver, contributes to the building of a health care system that delivers better care, spends health care dollars more wisely and results in healthier people.

The Program (which is specific to Fee-For-Service Medicare—not Medicare Advantage) contains two primary components:

  • Quality and Resource Use Reports (QRURs)
  • Development and implementation of the Value-Based Payment Modifier (Value Modifier).

The Value Modifier provides for differential payment under the Medicare Physician Fee Schedule (PFS) based on the quality of care furnished compared to the cost of care during a performance period. The Value Modifier is an adjustment made on a per claim basis to Medicare payments for items and services under the Medicare PFS.

Why?

CMS’ goal of shifting our payment systems to reward quality and lowering costs is essential for the health system to improve and be sustainable. The Physician Feedback/ Value Modifier Program further supports this goal of shifting Medicare payments from volume to value. The Physician feedback reporting was initiated under section 131 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), and was expanded by section 3003 of the Affordable Care Act of 2010. The Affordable Care Act directed CMS to provide information to physicians and group practices about the resources used and quality of care provided to their Medicare Fee-For-Service patients, including quantification and comparisons of patterns of resource use/cost among physicians and medical practice groups. Most resource use and quality information in the QRURs is displayed as relative comparisons of performance among similar physicians or groups. Section 3007 of the Affordable Care Act mandated that, the Value Modifier be applied to specific physicians and groups of physicians the Secretary determines appropriate starting January 1, 2015, and to all physicians and groups of physicians by January 1, 2017. Both cost and quality data are to be included in calculating the Value Modifier for physicians.