Another Change in Physician Pay Sneaking Up Fast

A quick tutorial of CMS' Value Modifier

When Benjamin Disraeli uttered the quote “Change is inevitable.  Change is constant,” he must have been talking about physician pay. 

Over the past decade, physician compensation has changed more times than Katie Perry’s hair color - and it’s often been just as perplexing.  Most have recovered from the initial shock of Meaningful Use, PQRS and ePrescribing… just in time for Value Based Purchasing.

Since the success of medical sales teams depends on understanding the challenges and priorities of healthcare providers and administrators, I thought I'd offer this quick tutorial.

According to CMS, “The Value Modifier provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule based upon the quality of care furnished compared to cost during a performance period.”

Huh?

Here’s the breakdown:

• Calculation of the Value Modifier will result in an upward, downward, or no payment adjustment based on performance.
• Physicians who practice in groups with 100 providers or more will lose 1% of their Medicare payments starting in 2015 based on performance in 2013 if they do not meet performance standards.
• Groups whose physicians participate as individuals under the PQRS must register as a group and elect the Administrative Claims reporting mechanism by October 15, 2013 in order to avoid the -1.0% downward Value Modifier payment adjustment.
• Physicians in smaller groups will be impacted by the value modifier in 2017, but will see changes in PQRS reporting in the meantime.

For the full story, check out the CMS.gov guide.