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2015 QRUR and 2017 Value Modifier

2015 QRURs

CMS made available two types of Quality and Resource Use Reports (QRURs) for 2015: the Mid-Year QRUR and the Annual QRUR. This page currently contains links to templates, methodologies and supporting information for the 2015 Mid-Year QRUR and 2015 Annual QRURs. 

2015 Annual QRURs (Available September 2016)

On September 26, 2016, CMS will make available the 2015 Annual QRURs to every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Medicare-enrolled Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2015, in addition to those TINs consisting only of non-physician eligible professional (EPs). The 2015 Annual QRURs show how groups and solo practitioners performed in 2015 on the quality and cost measures used to calculate the 2017 Value Modifier. For physicians in groups with 2 or more EPs and physician solo practitioners that are subject to the 2017 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 TIN in 2017. Authorized representatives of groups and solo practitioners can access the 2015 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 2015 Annual QRURs, please visit How to Obtain a QRUR.

For physician solo practitioners and physicians in groups with 2 or more EPs that are subject to the 2017 Value Modifier, CMS established an informal review period to request a correction of a perceived error in their 2017 Value Modifier calculation. The informal review period for the 2017 Value Modifier will open on September 26, 2016 and close on November 30, 2016 at 11:59 pm EST. Information about how to request an informal review is available below.

Resources:

For questions about the 2015 Annual QRUR, 2017 Value Modifier, and how to request an informal review of the 2017 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 documents below supplement and provide detailed information to accompany the 2015 Annual QRURs.

Detailed Methodology for the 2017 Value Modifier and 2015 Quality and Resource Use Report [PDF, 1MB]  

This document describes the methodology used to calculate the 2017 Value Modifier and develop the 2015 Mid-Year and 2015 Annual QRURs.

How to Understand Your 2015 Annual QRUR [PDF, 384KB]  

This document provides tips on how solo practitioners and groups can use the 2015 Annual QRUR and accompanying tables to understand their performance and to improve quality of care, streamline resource use, and identify care coordination opportunities for beneficiaries.

Questions and Answers About the 2015 QRURs and 2017 Value Modifier [PDF, 285KB]  

This document presents frequently asked questions (FAQs) and answers that groups and solo practitioners may have about the 2015 Mid-Year and Annual QRURs and the 2017 Value Modifier.

Computation of the 2017 Value Modifier 

 This document provides an overview of how the 2017 Value Modifier is calculated.

Medicare Shared Savings Program Interaction with the 2017 Value Modifier Frequently Asked Questions [PDF, 80KB]  

This guide describes the interactions between the Medicare Shared Savings Program and the 2017 Value Modifier

2017 Value Modifier Informal Review Request Quick Reference Guide [PDF, 3MB]  

This document illustrates how groups and solo practitioners that are subject to the 2017 Value Modifier can submit a 2017 Value Modifier Informal Review Request and how to modify or cancel an existing Value Modifier informal review request.

Sample 2015 Annual QRUR (Medical Practice A) [PDF, 624KB]

This document represents a sample 2015 Annual QRUR for a group with 10 or more EPs subject to the 2017 Value Modifier and for which CMS was able to calculate quality and cost composite scores. This group received a neutral payment adjustment under quality-tiering and did not participate in the Shared Savings Program in 2015.

Sample 2015 Annual QRUR (Medical Practice B) [PDF, 603KB]  

This document represents a sample 2015 Annual QRUR for a group with 10 or more EPs subject to the 2017 Value Modifier and for which CMS was able to calculate quality and cost composite scores. This group received an upward payment adjustment under quality-tiering and participated in the Shared Savings Program in 2015.

Sample 2015 Annual QRUR Tables [ZIP, 269KB]  

This folder contains the templates for the tables that are included with the 2015 Annual QRURs. The templates are provided in Excel and CSV format.

2015 Annual QRUR Data Dictionary [ZIP, 32KB]  

This file contains a list of all data element names with a brief description and location of where they appear in the 2015 Annual QRUR.

Fact Sheet for Attribution in the 2017 Value Modifier [PDF, 318KB]  

This document provides an overview of the two-step attribution methodology for the claims-based quality outcome measures and per capita cost measures included in the 2017 Value Modifier.

Fact Sheet for Specialty Adjustment in the 2017 Value Modifier [PDF, 78KB]  

This document provides an overview of the specialty adjustment methodology used in the 2017 Value Modifier.

Fact Sheet for Risk Adjustment in the 2017 Value Modifier [PDF, 272KB]  

This document provides an overview of the risk adjustment methodology used in the 2017 Value Modifier.

Measure Information Form: 30-Day All-Cause Hospital Readmission Measure used in the 2017 Value Modifier [PDF, 811KB]  

This document provides a detailed, methodological overview of the 30-Day All-Cause Hospital Readmission measure, calculated for the 2017 Value Modifier.

Measure Information Form: Ambulatory Care-Sensitive Condition (ACSC) Composite Measures used in the 2017 Value Modifier [PDF, 499KB]  

This document provides a detailed, methodological overview of the Hospital Admissions for Acute and Chronic ACSC Composite measures, calculated for the 2017 Value Modifier.

Measure Information Form: Overall Total Per Capita Cost Measure used in the 2017 Value Modifier [PDF, 284KB]  

This document provides a detailed, methodological overview of the Per Capita Costs for All Attributed Beneficiaries measure, calculated for the 2017 Value Modifier.

Measure Information Form: Condition-Specific Total Per Capital Cost Measures used in the 2017 Value Modifier [PDF, 379KB]  

This document provides a detailed, methodological overview of the four Per Capita Costs for Beneficiaries with Specific Conditions measures, calculated for the 2017 Value Modifier.

Measure Information Form: Medicare Spending Per Beneficiary Measure [PDF, 242KB]   

This document provides a detailed, methodological overview of the Medicare Spending Per Beneficiary measure, calculated for the 2017 Value Modifier.

2017 Value Modifier Results and Payment Adjustment Factor

CMS applies an upward, downward, or neutral Value Modifier payment adjustment to 2017 Medicare Physician Fee Schedule (PFS) payments to physicians based on the performance of their practice on quality and cost measures during the 2015 performance period. CMS announced results of the 2017 Value Modifier and the adjustment factor that will be applied to physician groups and physician solo practitioners receiving an upward payment adjustment in 2017. Physician group practices with 2 or more eligible professionals and physician solo practitioners are subject to the 2017 Value Modifier quality-tiering methodology.

Physician Value-Based Payment Modifier 2017 Adjustment Factor Calculation

Physician Solo Practitioners and Physician Groups Receive Upward, Neutral, or Downward Adjustments to their Medicare Payments in 2017 Based on Their Performance on Quality and Cost Efficiency Measures

2015 Annual QRURs Webcast

On September 29, 2016, CMS hosted a Webcast to provide an overview of the 2015 Annual QRURs and explain the information contained in these reports. The slide presentation, audio recording, and written transcript of the call are available.

Video: PQRS/Value-Based Payment Modifier: What Medicare Professionals Need to Know in 2015

What To Do In 2015 For The 2017 Value Modifier [PDF, 110KB]   

This document describes the action physician groups with 2 or more eligible professionals and physician solo practitioners need to take in CY 2015 in order to avoid the automatic downward payment adjustment and qualify for upward, neutral, or downward adjustments based on performance under the 2017 Value Modifier.

Quality Benchmarks for the 2017 Value Modifier and the 2015 Annual QRURs - Updated 6/15/16 [PDF, 606KB]  

The quality benchmarks shown in this document are the means and standard deviations for each measure that will be included in the Performance Year 2015 Annual QRURs and used in the calculation of the 2017 Value Modifier. The benchmarks for each quality measure are based on the performance of all solo practitioners and groups nationwide in 2014, the year prior to the performance year (2014 benchmarks for the 2015 performance year). A group or solo practitioner's individual measure score that is part of the overall quality composite for the Value Modifier depends on the group or solo practitioner’s performance rate relative to the benchmark for that measure. Groups and solo practitioners 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.

 

2015 Mid-Year QRURs (available April 2016)

In April 2016, CMS made available the 2015 Mid-Year QRURs (MY-QRURs) to groups and solo practitioners nationwide who billed for Medicare-covered services under a single Medicare-enrolled Taxpayer Identification Number (TIN) over the Mid-Year QRUR performance period (July 1, 2014 through June 30, 2015), and had at least one eligible case for one or more of the claims-based quality outcome or cost measures included in the Mid-Year QRURs. This performance period differs from the actual performance period used for the 2017 Value Modifier, which extends from January 1, 2015 through December 31, 2015. The Mid-Year QRUR report is provided for informational purposes only and will not affect a TIN’s Medicare Physician Fee Schedule payments.

The 2015 Mid-Year QRUR provides interim information about a TIN’s performance on the six cost measures and three claims-based quality outcome measures that are a subset of the measures that will be used to calculate the 2017 Value Modifier. This report does not contain performance information on quality measures submitted through the Physician Quality Reporting System (PQRS). Performance information on the quality outcome measures and cost measures may be different between a TIN’s 2015 Mid-Year QRUR and the 2015 Annual QRUR. The 2015 Annual QRUR will be available in Fall 2016 and will show the TIN’s actual performance on all of the quality measures and cost measures that will be used to calculate the 2017 Value Modifier.

Authorized representatives of groups and solo practitioners can access the 2015 Mid-Year QRUR 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 2015 Mid-Year QRURs, please visit How to Obtain a QRUR.

For questions about the 2015 Mid-Year QRURs, contact the Physician Value Help Desk.

The following documents supplement and provide detailed information to accompany the 2015 Mid-Year QRUR:

How to Understand Your 2015 Mid-Year QRUR [PDF, 351KB]  
This document provides tips on how groups and solo practitioners can use their Mid-Year QRUR and accompanying tables to understand their performance and to improve quality of care, streamline resource use, and identify care coordination opportunities for their beneficiaries.

Sample 2015 Mid-year QRUR [PDF, 204KB]  

This document represents a sample 2015 Mid-Year QRUR for a group or solo practitioner 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 2015 Mid-Year QRUR.

Sample 2015 Mid-Year QRUR Tables [ZIP, 92KB]  

This spreadsheet contains the templates for the tables that provide detailed information to accompany the 2015 Mid-Year QRURs.

2015 Mid-Year QRURs Webcast

On May 19, 2016, CMS hosted a Webcast to provide an overview of the 2015 Mid-Year QRURs and explain the information contained in these reports. The slide presentation, audio recording, and written transcript of the call are available.

Measure Information Form: Medicare Spending Per Beneficiary Measure [PDF, 250KB]  

This document provides a detailed, methodological overview of the Medicare Spending Per Beneficiary measure, calculated for the 2015 Mid-Year QRURs.