Value Modifier
The Medicare Value-Based Payment Modifier (Value Modifier) data contains the performance results of de-identified practices that were subject to the Value Modifier, such as the practices' quality and cost tiers along...
Freshness
- Last posted
- Period covered
- Jan 1, 2016 to Dec 31, 2016
- Update frequency
- Annually
Dates as CMS lists them in its catalog.
Columns 13
| Column | What it means | Type |
|---|---|---|
Unique identifier of practicepractice_id | string | |
Location (state) of practicestate | State in which practice is located | string |
Practice EP count categorynum_eps_vm | Practice eligible professional count category. 0 EPs=Zero eligible professionals. 1-9 EPs=One to nine eligible professionals. 10 to 99 EPs=10 to 99 eligible professionals. 100+ EPs=100 or more eligible professionals. | string |
Practice enrolled in MSSPmssp | Indicator for whether practice was a Medicare Shared Savings Program Accountable Care Organization practice in the performance year. Value equals 1 if practice was a Medicare Shared Savings Program Accountable Care Organization practice in the performance year. If not, the value equals 0. | number |
GPRO practicegpro | Indicator for whether practice registered to report data to the PQRS via the Group Practice Reporting Option (GPRO). Value equals 1 if practice registered to report data to the PQRS via the Group Practice Reporting Option (GPRO). If not, the value equals 0. | number |
Eligible for high-risk bonus adjustmentelig_up_adjust | Indicator for whether practice eligible for additional upward payment adjustment for treating disproportionate share of high-risk beneficiaries. N/A=Practice did not meet minimum PQRS reporting requirements in the performance year. Eligible=Practice eligible for additional upward payment adjustment for treating disproportionate share of high-risk beneficiaries. Not Eligible=Practice not eligible for additional upward payment adjustment for treating disproportionate share of high-risk beneficiaries. | string |
Practice met minimum PQRS reporting requirementscategory | Practice met minimum PQRS reporting requirements in the performance year. CAT1=Practice subject to the Value Modifier and met minimum PQRS reporting requirements in the performance year. CAT2=Practice subject to the Value Modifier and did not meet minimum PQRS reporting requirements in the performance year. | string |
Value Modifier payment adjustmentvm_payment_adj | Value Modifier payment adjustment for practices subject to the Value Modifier. AF=Adjustment Factor | number |
Updated Value Modifier payment adjustmentupdated_vm | Value Modifier payment adjustment, incorporating Informal Review change, if applicable. AF=Adjustment Factor | number |
Cost Composite Tier: High, Average, Low, N/Acost_comp_tier_text | Cost Composite Tier value determined based on Cost Composite Score (High, Average, Low, N/A). N/A*=Practice did not meet minimum PQRS reporting requirements in the performance year. Low=Practice's Cost Composite Score is at least one standard deviation below benchmark and statistically significantly different from benchmark. Average*=Practice's Cost Composite Score is less than one standard deviation away from the benchmark, practice's Cost Composite Score is at least one standard deviation from benchmark but not statistically significantly different from benchmark, or practice does not have at least minimum number of eligible cases for any cost measures included in Cost Composite. High=Practice's Cost Composite Score is at least one standard deviation above benchmark and statistically significantly different from benchmark. | string |
Quality Composite Tier: High, Average, Low, N/Aqual_comp_tier_text | Quality Composite Tier value determined based on Quality Composite Score (High, Average, Low, N/A). N/A*=Practice did not meet minimum PQRS reporting requirements in the performance year. Low=Practice's Quality Composite Score is at least one standard deviation below benchmark and statistically significantly different from benchmark. Average*=Practice's Quality Composite Score is less than one standard deviation away from the benchmark, practice's Quality Composite Score is at least one standard deviation from benchmark but not statistically significantly different from benchmark, or practice does not have at least minimum number of eligible cases for any quality measures with prior-year benchmark included in Quality Composite. High=Practice's Quality Composite Score is at least one standard deviation above benchmark and statistically significantly different from benchmark. | string |
(Rounded) Standardized Cost Composite Scorezb_cost_cmpscr_pool_rnd | Standardized Cost Composite Score, rounded to the nearest 0.01 | number |
(Rounded) Standardized Quality Composite Scorezb_qual_cmpscr_pool_rnd | Standardized Quality Composite Score, rounded to the nearest 0.01 | number |
No column matches that filter.
At a glance
- Catalog
- data.cms.gov
- Publisher
- Office of Enterprise Data and Analytics (OEDA)
- Rows
- 207,151
- Columns
- 13
- State column
state- Contact
- qpp@cms.hhs.gov
API
Free, no key needed. This request returns the first 10 rows as JSON:
https://data.cms.gov/data-api/v1/dataset/c3e8e9c3-5193-47fb-a5bb-d3ddb00e7197/data?size=10
To keep only one state, filter on the state column.
Versions 4
The newest version is the one linked above. Older releases stay on the official site.
- 2016-12-01posted Sep 11, 2025
- 2015-12-31posted Aug 4, 2022
- 2014-12-31posted Aug 4, 2022
- 2013-12-31posted Aug 4, 2022
CMS's description
The Medicare Value-Based Payment Modifier (Value Modifier) data contains the performance results of de-identified practices that were subject to the Value Modifier, such as the practices' quality and cost tiers along with any applicable Value Modifier payment adjustment. The Value Modifier provided for differential payment under the Medicare Physician Fee Schedule based on the quality of care furnished to Medicare beneficiaries compared to the cost of care during a performance period. Calendar Year 2015 was the first payment adjustment period under the Value Modifier based on performance in 2013. Calendar Year 2018 was the final payment adjustment period under the Value Modifier based on performance in 2016.
Methodology and other documents from CMS:
The summary at the top is the first sentence of this description. Record id cms:c3e8e9c3-5193-47fb-a5bb-d3ddb00e7197. This record as JSON.