VBPM: For groups of 10 or more Eligible Practitioners (EPs)

Beginning in 2016, Medicare will apply the Value-Based Payment Modifier (Value Modifier) to payments to physicians in groups of 10 or more eligible professionals (EPs).  2014 is the performance period for the Value Modifier that will be applied in 2016.

To avoid an automatic negative two percent (-2.0%) Value Modifier payment adjustment in 2016, EPs in groups of 10 or more MUST participate in and satisfy the Physician Quality Reporting System (PQRS) requirements in CY 2014, either as a group or as individuals. Below is a brief summary of the CMS Value Modifier guidance. (Full text is available here.)

Participating as a Group

A group with 10 or more can register to participate as a group in the 2014 PQRS GPRO until September 30, 2014 11:59 pm EDT. https://portal.cms.govus.

Participating as Individuals

No registration is necessary if a group with 10 or more participates as individuals if all participate and at least 50% of the EPs meet satisfactory reporting criteria as individuals. EPs who satisfactorily report/participate under PQRS as individuals will avoid the 2016 payment adjustment. EPs in the group who do not report/participate satisfactorily will be subject to the payment adjustment.

Important Note

Medicare will NOT apply the CY 2016 Value Modifier to a group of physicians if one or more physicians in the group participates in the Medicare Shared Savings Program, the Pioneer ACO Model, or the Comprehensive Primary Care Initiative in CY 2014.

For questions about the Value Modifier, the IACS sign up process, or participating in the 2014 PQRS as a group or individual, please contact the QualityNet Help Desk at 1-866-288-8912 or via email at qnetsupport@hcqis.org.
More information about the Value Modifier program

More information about the PQRS program

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