Take action this year to avoid value-based modifier penalties

Take action this year to avoid value-based modifier penalties

Optometrists can take action this year to avoid value-based modifier (VBM) penalties two years down the road.

Participation with the VBM program will help optometrists in the future as the new MIPS is implemented.

The VBM is a compilation of data elements that compares the costs of an individual doctor's care in relation to the quality of that care. Starting in 2017, it will affect how all doctors are paid under the Medicare fee-for-service program.

2015 will be the first year that the VBM will impact most optometrists as this is the first year that the VBM applies to doctors who are solo practitioners and those with 2 to 9 Physician Quality Reporting System (PQRS) eligible professionals in their practices. How you perform on your VBM score will determine what you get paid in 2017, the AOA explains in a new fact sheet on VBM. The Centers for Medicare and Medicaid Services will calculate scores based on quality and cost.

VBM plays an important role in the development of a new incentive program which was created by the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA).

Starting in 2019, the Merit-Based Incentive Payment System (MIPS) will combine VBM, the Physician Quality Reporting System (PQRS) and electronic health records (EHR) meaningful use, and begin rating doctors based on a 100-point scale that reflects performance on quality, resource use, clinical practice improvement activities and meaningful use of certified EHR technology.

"Optometrists should be aware that the VBM will not only impact reimbursement in 2017, but participation with the VBM program will also help optometrists in the future as the new merit-based incentive program is implemented," AOA explains in its fact sheet. ODs under the MIPS program will continue to get evaluated annually, based on the quality and costs of care they provide to patients.

AOA advises that there are several ways to avoid penalties in 2017:

  1. Participate in PQRS.
    CMS will be reviewing whether you participated in the PQRS to determine whether you qualify for an automatic payment reduction.

  2. Access Your Quality Resource and Use Report.
    Last fall, CMS made 2013 Quality and Resource Use Reports (QRURs) available to all physicians. The QRUR includes data that assesses your performance on cost measures and quality measures. "This will give you additional information regarding how CMS has assessed the cost and quality of care provided to certain patients and will help you to understand how the VBM will potentially impact reimbursement in 2017," notes AOA's fact sheet.

  3. Know how your practice might be evaluated and how you'll measure up.
    As an example, solo practitioners or those practices with two to nine doctors who successfully participate in PQRS will receive an upward or neutral payment adjustment, based on CMS' analysis. ODs should be aware that "comparative quality measures and cost data have been risk-adjusted to account for differences in patient characteristics that might affect costs or quality outcomes," AOA's fact sheet explains.

If you have any questions, contact Kara Webb, AOA associate director for coding and regulatory policy, at kcwebb@aoa.org.

May 21, 2015

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