A critical part of healthcare reform is The Centers for Medicare and Medicaid Services (CMS) focus on high-quality service and low cost of care. There is no clearer evidence of this effort than in the Value-Based Payment Modifier (VM) program that works in conjunction with the Quality and Resource Use Reports (QRURs). One benefit that comes with engaging an EHR consulting company like TempDev is practitioners can learn the ins and outs of this process to ensure not only the best possible patient outcomes but high performance and low-cost VM scores that may affect the practice revenue. What do you need to know about the Value-Based Modifier system?
What is the Value-Based Payment Modifier?The Value-Based Payment Modifier system is a mandate detailed in the 2010 Affordable Care Act (ACA). The U.S. healthcare system is undergoing a regulatory overhaul the includes electronic health records along with a change in the payment system for Medicare and Medicaid. CMS describes the VM program as something used as part of a larger shift to improve quality and efficiency in the healthcare industry. The Value-Based Payment Modifier system adjusts payments based on the quality of care offered by physicians, groups or other eligible professionals. That is a significant transition from the traditional fee-for-service model. CMS calculates a VM rating for each practice based on a composite quality and cost score. The quality option is based on six factors:
- Clinical process/effectiveness
- Patient and family engagement
- Population/public health
- Patient safety
- Care coordination
- Efficient use of medical resources
- Per capita costs for all attributed beneficiaries - A cost measure based on primary care services received.
- Per capita costs for beneficiaries with specific conditions - Cost measures for condition-specific services. The four conditions included are diabetes, COPD, coronary artery disease and heart failure.
What are the VM Changes for 2018?As with most aspects of the Affordable Care Act, VM changes come in stages. In 2018, CMS will apply the Value Modifier to payments due to all eligible professionals. That list consists of:
- Physician Assistants
- Nurse Practitioners
- Clinical Nurse Specialists
- Certified Registered Nurse Anesthetists