Tips to get ahead of Medicare’s Value Based Modifier (VBM)

Take the first step and report PQRS quality measures - This one’s obvious. You can’t avoid penalties – or gain incentives – for the VBM program without reporting PQRS. This year providers who have not participated in PQRS should begin to use it to avoid the penalty in 2018 and beyond. While the VBM program ultimately will roll into the merit-based incentive payment system (MIPS), which kicks off in 2017, the emphasis on quality reporting will not disappear – in fact, it will only become more ingrained in physician reimbursement.

The MIPS adjustment factor, which reflects the maximum payment penalty, jumps to 7% in 2021 and 9% in 2022, according to reimbursement data set forth in the Medicare Access and CHIP Reauthorization Act (MACRA). Choose measures that you can perform well on compared to existing benchmarks. For instance, a primary care practice may be well-suited for the measure Osteoporosis: Pharmacologic Therapy for Men and Women Aged 50 Years and Older, whereas Screening Colonoscopy Adenoma Detection Rate would not make sense.

Check out specialty measures sets where you can “find measures specific to certain specialties, such as ob/gyn, internal medicine, etc.  To find specialty-specific measures, go here – – and select your appropriate specialty to view the measures that most closely pertain to your practice.

Download and review quality and resource use reports (QRUR) when they become available. Last year, CMS released mid-year QRURs in April and final QRURs in September, so be on the lookout for similar release dates this year. The QRURs show how practices performed on the quality and cost measures that form the basis of the VBM program; access them to get an early look at how you’re performing and take note on areas you can improve.


Have questions? I’m here to help.