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2014 QRUR and 2016 Value Modifier

2014 QRURs

We made available two types of Quality and Resource Use Reports (QRURs) for 2014: the Mid-Year QRUR (MYQRUR) and the Annual QRUR. This page currently contains links to templates, methodologies and supporting information for the MYQRUR and the Annual QRUR. 

2014 Annual Quality and Resource Use Report

2014 Mid-Year Quality and Resource Use Report

 

2014 Annual Quality and Resource Use Reports (Available September 2015)

On September 9, 2015, CMS made available the 2014 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer ACO Model, or the Comprehensive Primary Care initiative in 2014, in addition to those TINs consisting only of non-physician eligible professional (EPs). The 2014 Annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. For groups with 10 or more EPs that are subject to the 2016 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who bill under the group’s TIN in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2016. Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role.  For more information on how to access the 2014 Annual QRURs, please visit How to Obtain a QRUR.

For groups with 10 or more EPs that are subject to the 2016 Value Modifier, CMS established a 60-day Informal Review Period that begins after the release of the 2014 Annual QRURs, to request a correction of a perceived error in their 2016 Value Modifier calculation. The informal review period for the 2016 Value Modifier is open from September 9, 2015 through December 16, 2015 11:59pm EST.  Information about how to request an informal review is available below.

Resources:

For questions about the 2014 QRUR and how to request an informal review of the 2016 Value Modifier, contact the Physician Value Help Desk.

  • Monday – Friday: 8:00 am – 8:00 pm EST
  • Phone: 1-888-734-6433 (select option 3)
  • Email: pvhelpdesk@cms.hhs.gov

The following documents supplement and provide detailed information to accompany the 2014 Annual QRURs:

Detailed Methodology for the 2016 Value Modifier and 2014 Quality and Resource Use Report [PDF, 740KB]

This document describes the methodology used to calculate the 2016 Value Modifier and develop the 2014 Mid-Year and 2014 Annual QRURs.

How to Understand Your 2014 Annual QRUR and Supplementary Exhibits [PDF, 378KB]

This document provides tips on how groups and solo practitioners can use the QRUR and supplementary exhibits to understand their performance and identify opportunities for improvement.

Questions and Answers About the 2014 QRURs and 2016 Value Modifier [PDF, 514KB]

This document presents frequently asked questions (FAQs) and answers that groups and solo practitioners may have about the 2014 Annual QRURs and the 2016 Value Modifier. This document also provides an overview of the changes between the 2013 QRURs and 2014 Annual QRURs.  

2016 Value Modifier Informal Review Request Quick Reference Guide [PDF, 4MB]

This document illustrates how groups with 10 or more EPs that are subject to the 2016 Value Modifier can submit a 2016 Value Modifier Informal Review Request and how to modify or cancel an existing Value Modifier informal review request.

Sample 2014 Annual QRUR [PDF, 571KB]

This document represents a sample 2014 Annual QRUR for a group with 100 or more EPs subject to the 2016 Value Modifier and for which CMS was able to calculate quality and cost composite scores.

Sample 2014 Annual QRUR Supplementary Exhibits [ZIP, 165KB]

This spreadsheet contains the templates for the 13 supplementary exhibits that provide detailed information to accompany the 2014 Annual QRURs.

2014 Annual QRUR Data Dictionary [ZIP, 32KB]

If you choose to download the 2014 Annual QRUR CSV file that is available in the “About the Data in this Report’” section of your Annual QRUR, this file contains a list of the data element names with a description and location of where they appear in the report.

Fact Sheet for the 2016 Value-Based Payment Modifier [PDF, 268KB]  

This document provides an overview of how the 2016 Value-Based Payment Modifier will be calculated.

Fact Sheet for Attribution in the Value-Based Payment Modifier Program [PDF, 222KB]  

This document provides an overview of the attribution methodology implemented in the Value-Based Payment Modifier Program.

Fact Sheet for Specialty Adjustment in the Value-Based Payment Modifier Program [PDF, 94KB]  

This document provides an overview of the specialty adjustment methodology implemented in the Value-Based Payment Modifier Program.

Fact Sheet for Risk Adjustment in the Value-Based Payment Modifier Program [PDF, 154KB]  

This document provides an overview of the risk adjustment methodology implemented in the Value-Based Payment Modifier Program.

Measure Information Form: Ambulatory Care-Sensitive Condition (ACSC) Composite Measures [PDF, 441KB]  

This document provides a detailed, methodological overview of the Ambulatory Care Sensitive Conditions measures, calculated for the Value-Based Payment Modifier Program.

Measure information Form: All Cause Hospital Readmission [PDF, 412KB]  

This document provides a detailed, methodological overview of the 30-Day All-Cause Hospital Readmission measure, calculated for the Value-Based Payment Modifier Program.

Measure Information Form: Overall Total Per Capita Cost Measure [PDF, 305KB]  

This document provides a detailed, methodological overview of the Overall Total Per Capita Cost measure, calculated for the Value-Based Payment Modifier Program.

Measure Information Form: Condition-Specific Total Per Capita Cost Measures [PDF, 312KB]  

This document provides a detailed, methodological overview of the Condition-Specific Total Per Capita Cost measures, calculated for the Value-Based Payment Modifier Program.

Medicare Spending Per Beneficiary Measure [PDF, 255KB]  

This document provides a detailed, methodological overview of the Medicare Spending per Beneficiary Measure, calculated for the Value-Based Payment Modifier Program. 

2016 Value Modifier Results and Upward Payment Adjustment Factor 

CMS made available results from the implementation of the 2016 Value Modifier and the adjustment factor that will be applied to physician groups that are subject to upward payment adjustments under the Value Modifier in 2016.

Physician Groups Receive Upward, Neutral, or Downward Adjustments to Their Medicare Payments in 2016 Based on Their Performance on Quality and Cost Efficiency Measures [PDF, 134KB]  

Physician Value-Based Payment Modifier 2016 X-Factor Calculation [PDF, 142KB]  

Quality Benchmarks for the 2016 Value Modifier and the 2014 Quality and Resource Use Reports 

The quality benchmarks shown in this document are the means and standard deviations for each measure that will be included in the Performance Year 2014 QRURs and used in the calculation of the 2016 Value Modifier. The benchmarks for each quality measure are based on the performance of all solo practitioners and groups nationwide in 2013, the year prior to the performance year (2013 benchmarks for the 2014 performance year). A group's individual measure score that is part of the overall quality composite for the Value Modifier depends on the group’s performance rate relative to the benchmark for that measure. Groups can use this document to review the benchmarks and see how their performance on each of the quality measures compares to the mean for all solo practices and groups nationwide.

Performance Year 2014 Prior Year Benchmark [PDF, 452KB]  

2014 Mid-Year Quality and Resource Use Report (available April 2015)

In April 2015, CMS made available the 2014 Mid-Year Quality and Resource Use Reports (MYQRURs) to physician solo practitioners and groups of physicians nationwide who (1) had at least one physician who billed for Medicare-covered services during the performance period from July 1, 2013 to June 30, 2014 and (2) had at least one quality or cost measure with at least one eligible case. We identified groups and solo practitioners by their Taxpayer Identification Number (TIN). MYQRURs provide interim information about performance on the six cost and three quality outcomes measures that we calculate directly from Medicare claims, based on care provided from July 1, 2013 through June 30, 2014. The MYQRUR will not affect a TIN’s payments under the Medicare Physician Fee Schedule; rather, the Mid-Year QRURs are feedback reports for informational purposes. The reports are intended to provide timely and actionable information to help Medicare enrolled physicians understand and improve the quality and efficiency of care provided to Medicare beneficiaries and to inform physicians about their performance on a subset of measures that will be included in the Value-Based Payment Modifier. The MYQRURs are available for groups and solo practitioners with physicians who participated in the Shared Savings Program, the Pioneer ACO Model, or the Comprehensive Primary Care (CPC) initiative in 2014.  The MYQRUR does not contain performance information on quality measures submitted through the Physician Quality Reporting System (PQRS).

The following documents supplement and provide detailed information to accompany the 2014 MYQRUR:

Questions and Answers about the 2014 Mid-Year and Annual Quality and Resource Use Reports [PDF, 516KB]

This document presents frequently asked questions (FAQs), and answers, that physicians and groups of physicians may have about the 2014 Mid-Year and Annual QRURs and the Value Modifier.

How to Use Your 2014 Mid-Year QRUR and Supplementary Exhibits [PDF, 201KB]

This document provides tips on how physicians and groups of physicians can use the Mid-Year QRUR and supplementary exhibits to understand their performance and to improve quality of care, streamline resource use, and identify care coordination opportunities for one’s beneficiaries.

Sample 2014 MYQRUR [PDF, 1MB]

This document represents a sample 2014 Mid-Year QRUR for physician groups or physician solo practitioners that had at least 20 eligible cases for at least one quality outcome measure or cost measure.  This document shows all of the exhibits that would be shown in the Mid-Year QRURs.

Sample 2014 MYQRUR Supplementary exhibits [ZIP, 50KB]

This spreadsheet contains the templates for the five supplementary exhibits that provide detailed information to accompany the 2014 Mid-Year QRURs.

2014 MYQRUR Data Dictionary [ZIP, 21KB]

If you choose to download the Mid-Year QRUR CSV file that is available on the “About the Data in this Report’” page of your Mid-Year QRUR, this file contains a list of the data element names with a description and location of where they appear in the report.