American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Physician Value-Based Payment Modifier

The Affordable Care Act (ACA) requires that the Centers for Medicare & Medicaid Services (CMS) implement a value-based payment modifier that would apply to Medicare fee-for-service payments starting with some physicians on January 1, 2015, and applying to all physicians and groups by January 1, 2017. The value-based payment modifier is intended to pay physicians differentially based on the quality of care they provide and the cost of that care. It would incorporate the use of Physician Feedback reports, which are confidential reports that quantify and compare the quality of care furnished and costs among physicians and physician group practices, relative to the performance of other physicians. 

Review a CMS presentation on the value-based payment modifier proposals in the CY 2013 Physician Fee Schedule proposed rule.

ACS comment letter that discusses proposals on the value-based payment modifier starting on page 25.

CMS rules that address changes to provider ordering and referring requirements are outlined in CY 2013 Physician Fee Schedule Proposed Rule.