Value-Based Payment Modifier Program (VBPM)

The Patient Protection and Affordable Care Act established the VBPM in order to provide comparative performance information to physicians as part of Medicare's efforts to improve the quality and efficiency of medical care. By providing meaningful and actionable information to physicians so they can improve the care they deliver, CMS is moving toward physician reimbursement that rewards value rather than volume. The implementation of the VBPM is required by law to be budget neutral.

How will the VBPM work?

  • CMS will use a quality-tiering approach to calculate the VBPM in order to identify both high and low performers for upward and downward payment adjustments.
  • The quality-tiering process involves comparing groups nationally on quality and cost.
  • Groups will be adjusted by specialty mix.
  • A threshold has been set in order to calculate a group quality score, defined as 50% of individual EPs in a group who meet the criteria to avoid the 2016 payment adjustment.
  • The VBPM adjustment is in addition to the PQRS payment adjustment.

Coming In 2015

Starting in 2015, physicians in groups of 100 or more EPs who submit claims to Medicare will be subject to the VBPM, based on their 2013 performance.

Groups that fail to report will be subject to a -1% value modifier adjustment to their 2015 payment.

Coming in 2016

In 2016, the VBPM will apply to groups of physicians with 10 or more EPs, based on their 2014 performance.

Groups that fail to report will be subject to a -2% value modifier adjustment to their 2016 payment.

Coming in 2017

By 2017, all physicians who participate in Medicare FFS will be affected by the value modifier, based on their 2015 performance.

Groups of 2-9 EPs and solo practitioners: the automatic downward adjustment for not successfully reporting PQRS is -2.0%; under quality-tiering, these EPs can earn only an upward or neutral adjustment and the maximum potential upward adjustment is +2.0X, where x represents the upward payment adjustment factor.

Groups with 10 or more EPs: those that fail to report will face an automatic downward adjustment of -4.0%. Under quality-tiering, the maximum potential upward adjustment is +4.0x.

For more information about the Value-Based Payment Modifier and how it may affect you and your practice, please visit:

The International Spine Intervention Society provides this information for educational purposes only and always recommends that providers consult the CMS Web site for additional information. It is each provider's responsibility to know and to understand the requirements and consequences of each reporting program in which he or she participates.

Contact Us

120 E. Ogden Ave. Ste. 202
Hinsdale, Illinois 60521
P: 630.203.2252
Toll Free: 888.255.0005

© Copyright 2016 Spine Intervention Society Privacy Policy  ::  Legal