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The Affordable Care Act requires Medicare to establish a Value Modifier that provides for differential payment to a physician or group of physicians under the Medicare Physician Fee Schedule (PFS) based upon the quality of care furnished to Medicare beneficiaries compared to the cost of that care during a performance period. Further, the statute requires that we begin applying the Value Modifier on January 1, 2015, with respect to items and services furnished by specific physicians and groups of physicians (as
determined by the Secretary) and to apply it to all physicians and groups of
physicians beginning not later than January 1, 2017. The statute requires that
payments made under the Value Modifier must be budget neutral meaning that
upward payment adjustments for high performance must balance the downward
payment adjustments applied for poor performance. The 2018 Value Modifier is
based on 2016 performance, and it will apply to payments to physicians,
physician assistants, nurse practitioners, clinical nurse specialists, and
certified registered nurse anesthetists, for items and services furnished under
the Medicare Physician Fee Schedule.
(FAQ10262)
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