Healthcare Business News

Specialist physicians cry foul on payment modifier

By Andis Robeznieks
Posted: November 9, 2012 - 11:45 am ET

The provisions of the quality-reporting programs laid out in the CMS' 2013 Medicare Physician Fee Schedule final rule (PDF) "pose unique and significant challenges to specialty physicians, diverting time and resources away from direct patient care," according to the Alliance of Specialty Medicine, a coalition of 13 physician specialty societies.

The Alliance's concerns involve the implementation of a value-based payment modifier—a mechanism that will create different levels of payment for physicians based on performance. The VBPM was created by the Patient Protection and Affordable Care Act and is scheduled to take effect for some physicians in 2015.

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"Many specialty practices are already juggling with current conflicting and overlapping quality reporting mandates,” said Alliance spokesman Dr. Alex Valadka, a neurosurgeon from Austin, Texas, in a news release (PDF). "VBPM is still in danger of being rushed onto physicians who may not have the resources or experience needed to comply."

The alliance said it was pleased with a change that limited application of the VBPM in the first year to group practices with 100 or more eligible professionals instead of just 25 as originally proposed. The VBPM is slated to be applied for all physicians in 2017.

"CMS is telling physicians to be up and running on VBPM in four short years, yet we still have no clear pathway ahead on any sort of reform in Medicare SGR reimbursement, and we are facing more financial upheaval with sequestration and IPAB cuts looming in the future and electronic health records and meaningful-use payments," Valadka added. "It strikes physicians as more than a little lopsided."

The CMS addressed the VBPM in an online commentary on the Journal of the American Medical Association website.

According to the editorial’s authors, Jordan VanLare, Jonathan Blum and Dr. Patrick Conway, reporting requirements for the VBPM are in sync with the CMS pay-for-reporting program known as the Physician Quality Reporting System and the federal meaningful-use health IT incentive program. Because of this, the authors write, “the value modifier should minimize complexity and burden for physicians."

“Hopefully,” the authors conclude, “the most profound effect of the value modifier in physicians' offices will be motivating the healthcare community to engage in quality measurement, find ways to improve quality and innovate care delivery.”

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