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As described in the CY 2025 PFS proposed rule (89 FR 61596), we chose QMB status as the method to identify beneficiaries with SDOH factors who may require relatively greater resources from practitioners that furnish advanced primary care services due to the strong evidence associated with dual eligibility for Medicare and Medicaid with poorer outcomes in Medicare Value-Based Purchasing (VBP) programs, in addition to the fact that we have QMB status in our administrative data (in contrast to other SDOH data elements) as well as the lack of cost sharing for QMBs

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Actual payment is calculated by multiplying total RVU by the geographic adjustment factor and the CMS conversion factor for that payment year

Furthermore, it has been observed to counteract various forms of systemic damage and conditions, including tumor cachexia and the adverse effects of certain medical agents

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