VBM x-factor will mean a 32% bonus for some practices

by: Julia Kyles, CPC Mar 7, 2016

Quality reporting in 2014 will really pay off for 128 groups this year. The baseline upward adjustment is 15.92% and that amount doubled for groups that treated high risk patients.

Where did the money for the bonuses come from? Groups that received value-based modifier (VBM) penalties. Because the VBM must be budget neutral, CMS bases the bonus calculation - known as the x-factor - on the amount of the penalties it will collect.

The majority of groups received a VBM cut because providers failed to successfully participate in the physician quality reporting system in 2014. That was an automatic 2% cut. A handful of groups - 59 - received a downward adjustment of 1% or 2% under the VBM quality tiering methodology, however groups with 100 or more eligible providers were subject to a downward adjustment during this reporting period. The program expanded to include any group with at least one physician in 2015.

Editor's note: Learn more about the value-based modifier during the April 6 webinar Master the Value-Based Modifier: Report successfully to gain -- not lose -- a 4% Medicare boost. Register at http://www.decisionhealth.com/conferences/a2660.

Blog Tags: CMS, health care reform, payment models, PQRS, quality of care, Value-based modifier

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