Here are some big numbers to chew on.
Barely 20,000 clinicians nationwide will get bonuses of 6.6 percent to 19.9 percent per claim in their Medicare Physician Fee Schedule payments this year, according to results of the final 2018 Value-Based Payment Modifier (VM) program.
Meanwhile, 296,475 clinicians will have their payments cut 1 percent to 2 percent per claim because of “failing quality reporting,” the Centers for Medicare & Medicaid Services (CMS) said. The penalties would’ve been higher ― up to 4 percent ― but the Texas Medical Association and organized medicine fought to have them eliminated or at least reduced.
More than 800,000 clinicians will see no change in payment, CMS said.
Medicare bonuses and penalties are based on quality and cost performance derived from data used in the 2016 VM program and data submitted to the 2016 Physician Quality Reporting System (PQRS).
VM and PQRS payment adjustments sunset at the end of the 2018 calendar year. Medicare bonuses and penalties in 2019 will be based on 2017 quality and cost performance under the Merit-Based Incentive Payment System (MIPS), which is one of two tracks in the Quality Payment Program.
CMS did not report state-level results, so at this time there’s no way to tell how Texas physicians fared regionally or in comparison to other states. Physicians and groups should refer to their quality and resource use report to review their 2016 quality and cost performance and quality-tier designation, and to ensure their 2018 Medicare payment aligns with CMS’ determination.
According to a recent study in the Annals of Internal Medicine, the VM program “was not associated with differences in performance on program measures. Performance differences between practices serving higher- and those serving lower-risk patients were affected considerably by additional adjustments, suggesting a potential for Medicare's pay-for-performance programs to exacerbate health care disparities.”
Because certain performance measurement concepts and measures used in VM are part of the new MIPS program, TMA will continue to evaluate CMS policies and advocate for fair measures and adequate risk adjustment methodologies.
More information can be found on the CMS Value-Based Payment Modifier and Quality Payment Program websites. For questions, contact the CMS Physician Value Help Desk by telephone at (888) 734-6433 (select option 3) or by email at pvhelpdesk[at]cms[dot]hhs[dot]gov.
As always, visit the TMA MACRA Resource Center for the latest information.