ObamaCare Soviet style bureaucracy will penalize Medicare practictioners for providing an 'expensive procedure'-Medscape

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12/4/13, "Two Medicare Incentive Programs Get a Little Tougher," Medscape.com, Robert Lowes

"Medical Societies Call VBM Changes Too Drastic

The final 2014 Medicare fee schedule also toughened up another incentive program called the Value-Based Payment Modifier, or VBM for short. Created by the Affordable Care Act (ACA), this pay-for-performance program applies a VBM — a percentage increase or decrease — to Medicare rates. Physicians practicing high-quality, low-cost medicine will earn a positive VBM, whereas physicians deemed low quality and high cost will receive a negative one. A physician's VBM will partly reflect quality-of-care data submitted through PQRS.

The VBM takes effect in 2015 for group practices with 100 or more physicians, nurse practitioners, physician assistants, and other eligible clinicians. Groups this size not participating in PQRS in 2013 will get hit in 2015 with a VBM of −1.0%, the maximum penalty. This comes on top of the PQRS penalty.

Under the latest Medicare fee schedule, the size of group practices subject to the VBM falls to 10 or more clinicians in 2016, and the maximum VBM penalty doubles to −2.0%.

Organized medicine had opposed these new rules when they were first proposed. AAFP Board Chair Glen Stream, MD, told CMS in a letter that the agency and physicians alike need to gain more experience with the VBM program before the penalty goes up. "Too rapid and too risky," the AMA's Dr. Madara said about the change.

Likewise, several medical societies complained that reducing the size of group practices subject to the VBM from 100 clinicians to 10 was too drastic. The American College of Physicians proposed making the new threshold 25 providers. The AMA suggested 50 clinicians.

Organized medicine was overruled again. However, even if CMS had heeded its requests on group size in the VBM program, the result would have been only a holding action. Under the ACA, groups of all sizes as well as solo physicians will see their Medicare rates adjusted upward or downward by the VBM beginning in 2017."


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