Put cost, quality data to use to outperform your peers for VBM incentives

Why This Topic Matters

The topic affects whether a practice may receive a payment adjustment or face a penalty under Medicare, so understanding the framework can help practices better align quality reporting and documentation efforts with their specialty and patient mix.

Article Sections

1. Quality reporting

   Introduces the relationship between quality reporting, cost performance, and Medicare payment adjustments under the value-based modifier program. It also frames the article’s emphasis on understanding performance categories and practice comparison groups.

2. Understand how your scores are calculated

   Summarizes the major components used to calculate the overall program score, including quality and cost considerations. It describes broad categories of measures and how practices are grouped for comparison.

3. Know which size category you fall into

   Explains that practices are evaluated within size-based peer groups and discusses why practice size can affect payment exposure. It highlights the importance of knowing which category a practice belongs to.

4. You have assigned patients – know which ones are attributed to you

   Covers the attribution concept and the role of assigned patients in the program’s quality and cost calculations. It also references CMS reporting resources used to identify attributed patients.

5. 2 more tips to improve your VBM scores

   Presents additional broad strategies for improving performance, including selecting appropriate specialty measures and documenting to a higher level of specificity. It also points to CMS specialty measure sets and practice resources.