CMS Releases Final Medicare Payment Rules for Value-Based Modifier, Chronic Care Management

CMS has released final rules outlining how Medicare will pay major healthcare providers and suppliers in 2015, including the Value-based Payment Modifier (VBM), which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and cost of care they furnish to beneficiaries. These adjustments translate into payment increases for providers who deliver higher quality care at a better value, while providers who underperform may be subject to a payment reduction.

In addition to the VBM, CMS’ final Medicare Physician Fee Schedule will include a new chronic care management fee beginning next year. This separate payment for chronic care management will support physician practices in their efforts to coordinate care for Medicare beneficiaries with multiple chronic conditions. This helps improve the way care is provided by supporting clinicians coordinating care for patients, including outside of regular office visits.

CMS also finalized hospital outpatient and ambulatory surgical centers policy and payment changes for 2015. A new comprehensive Ambulatory Payment Classifications payment policy is being implemented next year, under which a single payment will be made for all related hospital items and services, rather than separate payments for each supportive service.

Quality measure data available on the Physician Compare website will be expanded next year, making group practice and individual physician-level measures available for public reporting. Quality measures for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) will also change. The total number of measures will remain at 33, but CMS increased the number of measures calculated through claims and decreased the number of measures reported by ACOs through the group practice reporting option web interface. New measures will be added that focus on: avoidable readmissions for patients with multiple chronic conditions, heart failure and diabetes; depression remission; all-cause readmission to a skilled nursing facility; documentation of current medications; and stewardship of patient resources.

Source: CMS , October 31, 2014

Healthcare Trends & Forecasts in 2015: A Strategic Planning Session

Healthcare Trends & Forecasts in 2015: A Strategic Planning Session a 60-minute webinar on November 13, 2014, at 1:30 p.m. Eastern, Steven Valentine, president, The Camden Group, and Dorothy Moller, consultant, Navigant, will provide a roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2015.

This entry was posted in Accountable Care Organizations, affordable care act, Alternative Healthcare Coverage, Avoidable Hospitalization, Bundled Payments, Care Coordination, Case Managers, Disease Management, Healthcare Costs, Healthcare Reform, Physician Alignment and tagged , , , , . Bookmark the permalink.
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