Value-based payment modifier results: Less than 1% of groups earn bonuses

CMS has posted results from its implementation of the ACA’s value-based payment modifier program, and out of more than 13,800 eligible physician groups, just 128 groups—less than one percent—will receive “upward adjustments,” or bonuses, for strong performances. The rate for those adjustments is quoted as 15.92 percent, or 31.84 percent for some groups that treated high-risk beneficiaries.

The value-based payment modifier program is one of the numerous ways healthcare is currently transitioning from “volume and quantity” to “value and quality.” It uses Physician Quality Reporting System data to rate how physicians are performing compared to their peers.

To be eligible this year, medical groups must have included at least 10 eligible professionals. All eligible groups could earn bonuses, but only groups with 100 eligible professionals or more were at risk of facing a “downward adjustment,” or penalty.

The 128 groups receiving bonuses adds up to more than 4,000 physicians overall. On the other hand, more than 5,400 medical groups face a penalty of 2 percent for not meeting minimum reporting requirements, and 59 medical groups will be penalized 1 percent or 2 percent as a result of their performance.

Anders Gilberg, the Medical Group Management Association’s senior vice president of government affairs, told the Advisory Board Company that the program was “flawed” and that medical groups submitting data is "not a proxy for quality, but for your ability to code and document correctly."

The CMS statement about its value-based payment modifier program results can be found in full on its website.

Previous coverage of the value-based payment modifier can be found here and here, and here.