Introduction to value-based payment modifiers

Area of Science:

• Health Policy
• Healthcare Economics
• Medical Quality Improvement

Background:

• The Patient Protection and Affordable Care Act of 2010 introduced value-based payment modifiers.
• The legislation aims to transition physician reimbursement from fee-for-service to performance-based models.
• The Centers for Medicare & Medicaid Services (CMS) developed proposals for performance payment calculations.

Purpose of the Study:

• To outline the legislative intent and implementation timeline for value-based payment modifiers.
• To highlight the crucial role of medical specialty boards in developing and deploying performance measures.
• To discuss the anticipated impact of these measures on physician participation in quality reporting.

Main Methods:

• Analysis of the Patient Protection and Affordable Care Act legislation.
• Review of US Department of Health and Human Services and CMS proposals regarding physician payment.
• Examination of the collaborative efforts between CMS, medical specialty boards, and specialty societies.

Main Results:

• Performance payments will be a composite of quality and cost measures, with 2013 as the benchmark year.
• Implementation of performance measures begins in 2015, expanding to all physician payments by 2017.
• Specialty boards' measure development is seen as vital for increasing physician participation in quality reporting systems.

Conclusions:

• Medical specialty boards, such as the American Board of Radiology (ABR), play a significant role in the success of value-based payment reforms.
• Continued collaboration between the ABR, American Board of Medical Specialties, CMS, and specialty societies is essential.
• These efforts aim to enable ABR diplomates to meet Maintenance of Certification requirements, CMS incentive criteria, and avoid penalties simultaneously.