MDNews - Cleveland-Akron-Canton

BY MARTHA S. BETHEA, CPA PART OF THE AŸordable Care Act directed the Secretary of Health & Human Services to establish a budget-neutral Value-based Payment Modifier that provides for diŸerential payments under the Medicare fee schedule based on quality of care compared to the cost of care furnished to Medicare Fee-For-Service Beneficiaries. In 2015 this program only impacted groups with 100 or more eligible professionals. In 2016 the program expands to cover groups with 10 or more professionals. In 2017 the program expands to all physicians. In each of these years the program will not apply to groups in which one or more physicians participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model or in the Comprehensive Primary Care (CPC) initiative during the relevant performance period. For 2016 groups (those under the same tax identification number) will be classified as Category 1 or 2. Category 1 will include those groups in which at least 50 percent of eligible professions met the criteria to avoid the 2016 PQRS payment reduction. Category 2 includes those groups who did not meet the criteria for Category 1. Category 1 groups can earn an upward payment adjustment for demonstrating higher quality and/or lower cost. The size of the upward adjustment is based on the downward adjust- ments from low-performing groups. For 2016 groups from 10 to 99 eligible professionals may receive upward or neutral payment adjustments, but no downward adjustments while groups with 100 or more eligible professionals may receive upward, neutral or negative adjustments. Adjustments are based on the performance on quality and cost measures in 2014. Those groups falling into Category 2 will receive a 2 percent negative payment adjustment in addition to any PQRS negative payment adjustment. Quality domains include eŸective clinical care; person and caregiver-centered experience and outcomes; community/ population health; patient safety; communication and care coordination; e«ciency and cost reduction. Cost domains include per capita costs for all attributed beneficiaries and per capita costs for beneficiaries with specific conditions. Performance standards are measured against peer group benchmarks. These benchmarks are composed of groups nationwide that had at least 20 eligible cases for the measure during the year prior to the performance year. Overall composite scores are developed from these measures. 2014 Annual Quality and Resource Use Reports (Q PURs) have been distributed to every group practice and solo practitioner nationwide. Access is available through the Enterprise Identity Data Management (EIDM) account. This data is used to calculate the 2016 Value Modifier. An illustration of the development of these measures is beyond the scope of this article. CMS has provided a detailed Value Modifier Payment Adjustment example on pages 6–8 of its September 2015 fact sheet which can be accessed at cms.gov/medica re/medica re-fee-for-ser v ice-pay ment/ physicianfeedbackprogram. These programs are designed to meet the CMS goal that by 2018 90 percent of all Medicare fee-for-service payments will be tied to quality. Martha S. Bethea, CPA, is the Managing Director in charge of the Medical Practice Management G roup of CBIZ/MHM LLC in Akron, Ohio. ■ Value-based Payment Modifier Program 2016 Medicare Payment Initiatives — M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ M A R /A P R 2 016 2 5

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