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2016 QRUR and 2018 Value Modifier

Note: The final performance period for the Value Modifier program was 2016 and the final payment adjustment year is 2018. Therefore, the Quality and Resource Use Reports (QRURs) will no longer be available after the end of 2018. All QRURs provided under the Value Modifier program will remain available for download until December 31, 2018. Authorized representatives of groups and solo practitioners can access their QRURs at https://portal.cms.gov using an Enterprise Identity Management (EIDM) system account with the correct role. The QRURs can be downloaded as PDF or Excel files. For instructions on signing up for an EIDM account and accessing the QRURs, please visit the How to Obtain a QRUR webpage.

The Merit-based Incentive Payment System (MIPS) under the new Quality Payment Program replaced the Value Modifier program. We encourage everyone to learn more about the Quality Payment Program by visiting qpp.cms.gov. Please note that the QRURs are not the same as the MIPS Performance Feedback that is available under the Quality Payment Program.

2016 Annual QRURs

     On September 18, 2017, CMS made available the 2016 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner nationwide. The 2016 Annual QRURs show how physician, physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs) in groups and solo practitioners performed in 2016 on the quality and cost measures used to calculate the 2018 Value Modifier and payment adjustment. Groups and solo practitioners are identified in the QRURs by their Medicare-enrolled Taxpayer Identification Number (TIN). The 2018 Value Modifier payment adjustments shown in the 2016 Annual QRURs are based on policies finalized in the 2018 Medicare Physician Fee Schedule Final Rule (82 FR 53227-53232).

     Groups and solo practitioners may request an informal review of perceived errors in their 2018 Value Modifier calculation. Requests for an informal review of your 2018 Value Modifier calculation may be made during the informal review period between September 18, 2017 through December 1, 2017 8:00 pm Eastern Time. Click here to find information about how to request an informal review.

     The 2016 Annual QRURs show how groups and solo practitioners performed on quality and cost measures relative to national benchmarks and indicate if physicians, PAs, NPs, CNSs, and CRNAs will receive an upward, neutral or downward Value Modifier adjustment to their payments for items and services rendered under the Medicare Physician Fee Schedule in 2018. The QRURs also contain important information about care delivered to Medicare beneficiaries that can be used to better understand quality and cost performance and that can be used to improve quality and better coordinate care, including information about the hospital and other providers that see your patients.

     Authorized representatives of groups and solo practitioners can access the 2016 Annual QRURs and file an informal review on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For instructions on signing up for an EIDM account and how to access the 2016 Annual QRURs, please visit How to Obtain a QRUR.

Resources:

For questions about the 2016 Annual QRUR, 2018 Value Modifier, and how to request an informal review of the 2018 Value Modifier, contact the Physician Value Help Desk.

  • Monday – Friday: 8:00 am – 8:00 pm EST
  • Phone: 1-888-734-6433 (select option 4)
  • Email: pvhelpdesk@cms.hhs.gov

The documents below supplement and provide detailed information to accompany the 2016 Annual QRURs.

2018 Value Modifier Program Experience Report

2018 Value Modifier Program Experience Report [PDF, 518KB]  

The 2018 Value Modifier Program Experience Report highlights characteristics of the practices subject to the Value Modifier in 2018 and compares program results across 2015, 2016, 2017, and 2018. The report also includes the 2016 quality and cost measure performance for all practices subject to the 2018 Value Modifier, including their quality-tiering and payment adjustment category, quality reporting method, and performance by physician specialty.

2016 Value Modifier Public Use File

CMS released a de-identified Public Use File, which contains data about practices subject to the 2018 Value Modifier. The information provides the 2018 Value Modifier quality and cost tiers along with the payment adjustments for each practice based on their performance in 2016.

2018 Value Modifier Results and Upward Payment Adjustment Factor 

CMS applies an upward or neutral Value Modifier payment adjustment to 2018 Medicare Physician Fee Schedule payments to physicians, PAs, NPs, CNSs, and CRNAs based on the performance of their practice on quality and cost measures during the 2016 performance period. CMS announced results of the 2018 Value Modifier and the adjustment factor that will be applied to groups and solo practitioners receiving an upward payment adjustment in 2018. The payment adjustment factor in 2018 is +6.6%.

Detailed Methodology for the 2018 Value Modifier and 2016 Quality and Resource Use Report [PDF, 1MB]

This document describes the methodology used to calculate the 2018 Value Modifier and develop the 2016 Annual QRURs.

How to Understand Your 2016 Annual QRUR [PDF, 452KB]

This document provides tips on how solo practitioners and groups can use the 2016 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. 

2018 Value Modifier Informal Review Request Quick Reference Guide [PDF, 2MB]

2018 Value Modifier Informal Review Request Quick Reference Guide (condensed version) [PDF, 827KB]

These documents illustrate how groups and solo practitioners that are subject to the 2018 Value Modifier can submit a 2018 Value Modifier Informal Review Request and how to modify or cancel an existing Value Modifier informal review request.

2018 Value Modifier Informal Reviews Frequently Asked Questions [PDF, 116KB]  

This document presents frequently asked questions (FAQs) and answers that groups and solo practitioners may have about submitting a 2018 Value Modifier Informal Review.

Questions and Answers About the 2016 QRURs and 2018 Value Modifier [PDF, 502KB]

This document presents frequently asked questions (FAQs) and answers that groups and solo practitioners may have about the 2016 Annual QRURs and the 2018 Value Modifier.

Medicare Shared Savings Program Interaction with the 2018 Value Modifier Frequently Asked Questions [PDF, 208KB]

This guide describes the interactions between the Medicare Shared Savings Program and the 2018 Value Modifier.

Performance Year 2016 Prior Year Benchmark [PDF, 1MB]

The quality benchmarks shown in this document are the means and standard deviations for each measure that will be included in the Performance Year 2016 Annual QRURs and used in the calculation of the 2018 Value Modifier. The benchmarks for each quality measure are based on the performance of all solo practitioners and groups nationwide in 2015, the year prior to the performance year (2015 benchmarks for the 2016 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.

Means and Standard Deviations Used to Compute Quality and Cost Composite Scores for the Calendar Year 2015-2018 [PDF, 209KB]  

This document displays the peer group means and standard deviations used to calculate the Quality and Cost Composite Scores for each payment adjustment period under the Value Modifier.

Computation of the 2018 Value Modifier [PDF, 557KB]

This document provides an overview of how the 2018 Value Modifier is calculated.

Sample 2016 Annual QRUR (Medical Practice A) [PDF, 638KB]

This document represents a sample 2016 Annual QRUR for a group with 10 or more eligible professionals subject to the 2018 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 2016.

Sample 2016 Annual QRUR (Medical Practice B) [PDF, 649KB]

This document represents a sample 2016 Annual QRUR for a group with 10 or more eligible professionals subject to the 2018 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 2016.

2016 Annual QRUR Tables [ZIP, 259KB]

This folder contains the templates for the tables that are included with the 2016 Annual QRURs. The templates are provided in Excel and CSV format.

2016 Annual QRUR Data Dictionary [ZIP, 24KB]

This is a data dictionary that supports the Comma Separated Values (CSV) file that contains raw data in the 2016 Annual QRUR. This file provides a list of all data element names with a brief description and location of where they appear in the 2016 Annual QRUR.

Fact Sheet for Attribution in the 2018 Value Modifier [PDF, 304KB]

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 2018 Value Modifier.

Fact Sheet for Specialty Adjustment in the 2018 Value Modifier [PDF, 237KB]

This document provides an overview of the specialty adjustment methodology used in the 2018 Value Modifier.

Fact Sheet for Risk Adjustment in the 2018 Value Modifier [PDF, 259KB]

This document provides an overview of the risk adjustment methodology used in the 2018 Value Modifier.

Measure Information Form: 30-Day All-Cause Hospital Readmission Measure used in the 2018 Value Modifier [PDF, 391KB]

This document provides a detailed, methodological overview of the 30-Day All-Cause Hospital Readmission measure, calculated for the 2018 Value Modifier.

Measure Information Form: Ambulatory Care-Sensitive Condition (ACSC) Composite Measures used in the 2018 Value Modifier [PDF, 459KB]

This document provides a detailed, methodological overview of the Hospital Admissions for Acute and Chronic ACSC Composite measures, calculated for the 2018 Value Modifier.

Measure Information Form: Medicare Spending Per Beneficiary Measure [PDF, 258KB]

This document provides a detailed, methodological overview of the Medicare Spending Per Beneficiary measure, calculated for the 2018 Value Modifier.

Measure Information Form: Overall Total Per Capita Cost Measure used in the 2018 Value Modifier [PDF, 245KB]

This document provides a detailed, methodological overview of the Per Capita Costs for All Attributed Beneficiaries measure, calculated for the 2018 Value Modifier.

Measure Information Form: Condition Specific Per Capita Costs [PDF, 245KB]

This document provides a detailed, methodological overview of the four Per Capita Costs for Beneficiaries with Specific Conditions measures, calculated for the 2018 Value Modifier.

2016 Annual QRURs Webcast 

On October 19, 2017, CMS held a webcast that provided an overview of the 2016 Annual QRUR and explained how to interpret and use the information in the report.

 

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