The Value Modifier Program: Improve Performance, Payment

By Clifford Moy, MD, medical director for behavioral health, TMF Health Quality Institute

As the Centers for Medicare & Medicaid Services (CMS) continues to refine and expand the physician value-based payment modifier program, physicians and health care providers must understand and stay current with the new methodology in order to achieve performance goals for better payment. The value modifier combines Physician Quality Reporting System (PQRS) quality measures, cost measures, and a payment adjustment for physicians. 

To help accomplish that, TMF Health Quality Institute — the Medicare Quality Innovation Network Quality Improvement Organization (QIN-QIO) for Texas, Oklahoma, Arkansas, Missouri, and Puerto Rico — provides free education and technical support to help physicians and health care providers meet the evolving value modifier requirements. 

TMF has a successful history of working with physicians and physician practices across the state to help them meet the reporting requirements for various programs, including PQRS. TMF now also works with physicians and physician practices to provide free assistance to help them meet the requirements of the value modifier program. Part of that assistance is to help physicians and physician offices understand how the value modifier is calculated. The scoring is noted within the Quality and Resource Use Report (QRUR). Below are some recent updates related to the QRUR: 

  • On Sept. 9, 2015, CMS made available the 2014 annual QRURs to every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by taxpayer identification number (TIN).
  • The 2014 annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 value modifier. For groups with 10 or more eligible providers who are subject to the 2016 value modifier, the QRUR shows how the value modifier will apply to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who bill under the group's TIN in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2016.
  • Authorized representatives of group and solo practitioners can access the 2014 annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management account with the correct role. For more information, visit How to Obtain a QRUR
  • CMS established a 60-day informal review period that begins after the release of the 2014 annual QRURs to request a correction of a perceived error in CMS' 2016 value modifier calculation. The informal review period for the 2016 value modifier is open through Nov. 9, 2015. For more information about the 2014 annual QRURs, visit the CMS 2014 Annual Quality and Resource Use Reports webpage.  

The TMF QIN-QIO Value-Based Improvement and Outcomes Network provides more information about these topics, as well as upcoming educational events and resources. If you aren't already a member of this network, create a free account, and then join the Value-Based Improvement and Outcomes Network. As a member benefit, quality improvement consultants will work directly with you and your staff to help you understand reporting requirements and ensure your practice receives the reimbursements it is entitled to. 

Email Suzie Buhr, TMF QIN-QIO quality improvement consultant, with questions and for more information, or call (214) 477-1407.

Clifford Moy, MD, serves as TMF's medical director for behavioral health. He supports TMF's medical directors on the Texas Medicaid & Healthcare Partnership project and helps develop and operationalize behavioral health quality improvement opportunities. Dr. Moy is board-certified by the American Board of Psychiatry and Neurology.

Action, Oct. 15, 2015

Last Updated On

April 19, 2018