Medicare FFS Physician Feedback Program/Value-Based Payment Modifier
Value Modifier Program Transition to the Quality Payment Program
CMS' goal of shifting its payment systems to reward quality and lowering costs is essential for the health system to improve and maintain sustainability. The Physician Feedback/Value-Based Payment Modifier (Value Modifier) program further supported this goal of shifting Medicare payments from volume to value.
The Value Modifier provided for differential payment under the Medicare Physician Fee Schedule (PFS) based on the quality of care furnished to Medicare beneficiaries compared to the cost of care during a performance period. The Value Modifier was an adjustment made to Medicare payments for items and services under the Medicare PFS. 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. Beginning January 1, 2018, the Value Modifier applied to all physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. Both cost and quality data were included in calculating the Value Modifier.
The Physician Feedback Program provided comparative performance information to solo practitioners 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 solo practitioners and medical practice groups 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 Physician Feedback Program 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.
Calendar Year 2015 was the first payment adjustment period under the Value Modifier based on performance in Calendar Year 2013. Calendar Year 2018 was the final payment adjustment period under the Value Modifier based on performance in Calendar Year 2016. Therefore, the Quality and Resource Use Reports (QRURs) that provided feedback to solo practitioners and medical group practices are no longer available after December 31, 2018. Frequently asked questioned (FAQs) related to the end of the Value Modifier program are available in the FAQs about the QRURs and Value Modifier document.
The Merit-based Incentive Payment System (MIPS) under the Quality Payment Program has replaced the Value Modifier program. The Centers for Medicare & Medicaid Services (CMS) encourages everyone to learn more about the Quality Payment Program by visiting https://qpp.cms.gov/. Please note that the QRURs are not the same as the MIPS Performance Feedback available under the Quality Payment Program.
For questions about the Value Modifier or the Quality Payment Program, contact the Quality Payment Program Service Center by phone at 1-866-288-8292 or by email at QPP@cms.hhs.gov. The Service Center is available Monday – Friday; 8:00 A.M. – 8:00 P.M. Eastern Time Zone.
- Page last Modified: 07/29/2019 10:36 AM
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