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January 25, 2018

Nearly 300,000 docs will be penalized under VBM program in 2018

Daily Briefing

    The majority of eligible health care professionals will not receive any payment adjustments under CMS' value-based payment modifier (VBM) program in 2018, according to a recent CMS notice.


    Medicare uses the VBM program to adjust eligible professionals' reimbursement rates based on how physicians or medical groups perform on certain quality and cost measures, with quality metrics varying by specialty. The reimbursement rate adjustments for 2018—the final year of the program before providers move to MACRA's Quality Payment Program—are based on 2016 Physician Quality Reporting System (PQRS) data.

    Eligible professionals who meet minimum quality reporting requirements receive either neutral or positive payment adjustments, while those who do not meet minimum quality reporting requirements receive downward payment adjustments.

    2018 VBM payment adjustments

    Out of the more than one million health care professionals subject to VBM for the 2018 payment year, just 1.8%—or 20,481—will receive positive payment adjustments, with their 2018 Medicare reimbursement rates increasing by between 6.6% and 19.9%.

    Meanwhile, 121,642 medical groups—totaling 296,475 clinicians—will incur a 1% to 2% Medicare pay cut for not submitting their data.

    CMS said the "overwhelming majority of clinicians" will not receive any payment adjustments, in part because 87,841 were "held harmless as a result of policy changes" to the 2018 physician fee schedule (Dickson, Modern Healthcare, 1/22; Rappleye, Becker's Hospital CFO Report, 1/19; Finnegan, FierceHealthcare, 1/23; CMS factsheet, 1/12).

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