Skip to Main Content

Timeline to Phase In the Value-Based Payment Modifier

What to Expect in 2018

January 1: Application of the Value-Based Payment Modifier (Value Modifier)
The Value Modifier applies to payments under the Medicare Physician Fee Schedule (PFS) for physicians,  physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who are solo practitioners and physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in groups with 2 or more eligible professionals (EPs) based on performance in CY 2016.

CY 2018 will be the final payment adjustment period under the Value Modifier.

What to Expect in 2017

January 1: Application of the Value Modifier
The Value Modifier applies to physician payments under the Medicare PFS for physician solo practitioners and physicians in groups with 2 or more EPs based on performance in CY 2015.

Fall: Release of the 2016 Annual QRUR
For all groups and solo practitioners nationwide, CMS will make available annual QRURs based on quality and cost data from CY 2016. The reports will show the 2018 Value Modifier payment adjustment under the Medicare PFS for physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who are solo practitioners and physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in groups with 2 or more EPs.  

What to Expect in 2016

January 1: Application of the Value Modifier
The Value Modifier applies to physician payments under the Medicare PFS for physicians in groups with 10 or more EPs based on performance in CY 2014.

April 1- June 30: 2016 PQRS GPRO Registration Open
Groups with 2 or more EPs can register to participate in the 2016 PQRS GPRO. Physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists in groups of all sizes and those who are solo practitioners are subject to the Value Modifier in 2018, based on performance in CY 2016. Satisfactorily reporting via a 2016 PQRS GPRO is one of the ways groups can avoid automatic downward adjustments and qualify for adjustments based on their performance, under the Value Modifier in 2018.

April: Release of the 2015 Mid-Year QRUR
For all groups and solo practitioners nationwide, CMS will make available mid-year QRURs based on claims-based quality outcomes and cost data from July 1, 2014 through June 30, 2015. The reports are for informational purposes only and do not affect payments under the Medicare PFS. More information about the 2015 mid-year QRURs are available on the 2015 QRUR and 2017 Value Modifier webpage.

September: Release of the 2015 Annual QRUR
For all groups and solo practitioners nationwide, CMS will make available QRURs based on quality and cost data from CY 2015. The reports will show the 2017 Value Modifier payment adjustment under the Medicare PFS for physician solo practitioners and physicians in groups with 2 or more EPs. More information about the 2015 annual QRURs and 2017 Value Modifier are available on the 2015 QRUR and 2017 Value Modifier webpage. 

What to Expect in 2015

January 1: Application of the Value Modifier
The Value Modifier applies to physician payments under the Medicare PFS for physicians in groups with 100 or more EPs based on performance in CY 2013.

April 1 – June 30: 2015 PQRS GPRO Registration Open
Groups with 2 or more EPs can register to participate in the 2015 PQRS GPRO. Physician groups of all sizes and physician solo practitioners are subject to the Value Modifier in 2017, based on performance in CY 2015. Satisfactorily reporting via a 2015 PQRS GPRO is one of the ways groups can avoid automatic downward adjustments and qualify for adjustments based on their performance, under the Value Modifier in 2017.

April: Release of the 2014 Mid-Year QRUR
For all physician groups and physician solo practitioners nationwide, CMS made available mid-year QRURs based on claims-based quality outcomes and cost data from July 1, 2013 through June 30, 2014. The reports are for informational purposes only and do not affect payments under the Medicare PFS.  More information about the 2014 mid-year QRURs are available on the 2014 QRUR and 2016 Value Modifier webpage.

September: Release of the 2014 Annual QRUR
For all groups and solo practitioners nationwide, CMS made available annual QRURs based on quality and cost data from CY 2014. The reports show the 2016 Value Modifier payment adjustment under the Medicare PFS for physicians in groups with 10 or more EPs. More information about the 2014 annual QRURs and 2016 Value Modifier are available on the 2014 QRUR and 2016 Value Modifier webpage.

What to Expect in 2014

April 1 - October 3: 2014 PQRS GPRO Registration Open
Groups with 2 or more EPs can register to participate in the 2014 PQRS GPRO.  Physician groups with 10 or more EPs are subject to the Value Modifier in 2016, based on performance in CY 2014. Satisfactorily reporting via a 2014 PQRS GPRO is one of the ways groups can avoid automatic downward adjustments and qualify for adjustments based on their performance, under the Value Modifier in 2016.

September: Release of the 2013 QRURs
For all physician groups and physician solo practitioners nationwide, CMS made available QRURs based on quality and cost data from CY 2013. For groups with 100 or more EPs that elected quality-tiering, the QRURs showed the group’s 2015 Value Modifier payment adjustment under the Medicare PFS. More information about the 2013 QRURs and 2015 Value Modifier are available on the 2013 QRUR and 2015 Value Modifier webpage.

What to Expect in 2013

July 15 –October 18: 2013 PQRS GPRO Registration Open
Groups with 2 or more EPs can register to participate in the 2013 PQRS GPRO. Groups with 100 or more EPs were required to register to participate in the 2013 PQRS GPRO and meet the minimum reporting requirements in order to qualify to earn incentives (if quality-tiering is elected) and avoid a downward payment adjustment under the Value Modifier in 2015.