How CMS’ Value-Based Modifier Program May Affect Emergency Physicians

(Click for larger image) Table 2. Calculation of the 2017 VBM, Small Groups and Solo Practitioners
x = Upward payment adjustment factor to be determined by CMS.
* = Eligible for an additional +1.0x if reporting clinical data for quality measures and average beneficiary risk score in the top 25 percent of all beneficiary risk scores.

VBM Penalty for Failure to Satisfy PQRS Reporting Requirements

All group practices and solo practitioners must satisfy PQRS requirements in 2015 to avoid a separate penalty under the VBM in 2017 of up to 6 percent of their Medicare allowable. Groups of >10 eligible providers that fail to satisfactorily report PQRS in 2015 will receive a 2 percent PQRS penalty as well as an automatic 4 percent penalty under the VBM program (see Table 1). The penalty will be applied in 2017 and for many groups would result in a potential loss of roughly $5,000 per physician. Small groups with two to nine eligible providers would experience a loss of roughly $3,500 (see Table 2).

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