124 STAT. 375 PUBLIC LAW 111–148—MAR. 23, 2010 the payment modifier established under this sub- section with respect to 2015. ‘‘(II) PROVISION OF INFORMATION DURING INI- TIAL PERFORMANCE PERIOD.—During the initial performance period, the Secretary shall, to the extent practicable, provide information to physi- cians and groups of physicians about the quality of care furnished by the physician or group of physicians to individuals enrolled under this part compared to cost (as determined under paragraphs (2) and (3), respectively) with respect to the performance period. ‘‘(iii) APPLICATION.—The Secretary shall apply the payment modifier established under this subsection for items and services furnished— ‘‘(I) beginning on January 1, 2015, with respect to specific physicians and groups of physicians the Secretary determines appropriate; and ‘‘(II) beginning not later than January 1, 2017, with respect to all physicians and groups of physi- cians. ‘‘(C) BUDGET NEUTRALITY.—The payment modifier established under this subsection shall be implemented in a budget neutral manner. ‘‘(5) SYSTEMS-BASED CARE.—The Secretary shall, as appro- priate, apply the payment modifier established under this sub- section in a manner that promotes systems-based care. ‘‘(6) CONSIDERATION OF SPECIAL CIRCUMSTANCES OF CERTAIN PROVIDERS.—In applying the payment modifier under this sub- section, the Secretary shall, as appropriate, take into account the special circumstances of physicians or groups of physicians in rural areas and other underserved communities. ‘‘(7) APPLICATION.—For purposes of the initial application of the payment modifier established under this subsection during the period beginning on January 1, 2015, and ending on December 31, 2016, the term ‘physician’ has the meaning given such term in section 1861(r). On or after January 1, 2017, the Secretary may apply this subsection to eligible profes- sionals (as defined in subsection (k)(3)(B)) as the Secretary determines appropriate. ‘‘(8) DEFINITIONS.—For purposes of this subsection: ‘‘(A) COSTS.—The term ‘costs’ means expenditures per individual as determined appropriate by the Secretary. In making the determination under the preceding sentence, the Secretary may take into account the amount of growth in expenditures per individual for a physician compared to the amount of such growth for other physicians. ‘‘(B) PERFORMANCE PERIOD.—The term ‘performance period’ means a period specified by the Secretary. ‘‘(9) COORDINATION WITH OTHER VALUE-BASED PURCHASING REFORMS.—The Secretary shall coordinate the value-based pay- ment modifier established under this subsection with the Physi- cian Feedback Program under subsection (n) and, as the Sec- retary determines appropriate, other similar provisions of this title. Determination. Effective date. Determination. Time period. Applicability. Deadline. Effective date.
