AAMC Contact: Mary Wheatley mwheatley@aamc 202-862-6297 August 2013

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QRUR and Value Modifier: Medicare Physician Report Card and Pay-for Performance Program. AAMC Contact: Mary Wheatley mwheatley@aamc.org 202-862-6297 August 2013. What are Quality Resource Use Reports (QRUR) and Value Modifier? . - PowerPoint PPT Presentation

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AAMC Contact:Mary Wheatleymwheatley@aamc.org202-862-6297

August 2013

QRUR and Value Modifier: Medicare Physician Report Card and Pay-for Performance Program2What are Quality Resource Use Reports (QRUR) and Value Modifier? 2QRUR Report cards, based on 2012 data, expected mid-September 2013 for groups with 25 or more professionalsProcess to Determine QRUR and VM PQRSData3Non-PQRS Outcome Measures (from claims)Cost Measures (from claims)Quality Composite ScoreCost Composite ScoreQuality & Resource Use Reports (QRUR)Payment Adjustment based on scores (Quality Tiering)+Groups decide which PQRS/quality reporting to choose. Automatic penalty for not submitting PQRS data.InputsCalculationOutputsCMS Calculates Quality and Cost Composite ScoresCMS releases report with benchmark data to groups.

Medicare Part B payments adjusted based on scores.

Pay-for-PerformancePrivate Feedback ReportGray - Data supplied by physician groups Green Data supplied by CMS32015 VM Affects Most Large Group PracticesGroup with 100 EPs/TIN in 2013?*2013 Group Reporting or Admin Claims?Excluded from 2015 VMIncluded in 2017 VM-1.0% Penalty in 2015

0.0% Penalty (No Adjustment) in 2015

Upward or Downward adjustment based on Cost and Quality PerformanceNONOYESYESOptional : Quality Tiering* VM excludes groups participating in Pioneer or MSSP ACOs.44Large groups (100 or more eligible professionals) must report quality data as a group to avoid automatic VM cut 2013: Possible +0.5% incentive for the Physician Quality Reporting System (PQRS)2015: Avoids additional -1.5% reduction for PQRS Reporting options vary by the size of the group. For large groups, the choices are:GPRO Web InterfaceRegistryAdministrative claims (available for 2013)EHR (starting in 2014)(See appendix for more details)

5Groups Must Choose PQRS Reporting Option5Quality MeasuresPQRS reported measures (varies by reporting method)

3 claims-based outcome measuresAcute prevention quality indicators compositeChronic prevention quality indicators compositeAll cause readmissionCost MeasuresTotal cost per capita

Per capita costs for 4 condition populationsCOPDHeart FailureCoronary Artery DiseaseDiabetes

Cost measures risk-adjusted and price-standardized

VM - Quality and Cost Measures66Performance reported through Quality Resource Use Report (QRUR)

6Value Modifier Composite7

Quality and cost measures roll-up into domains. Each domain is weighted equally.7Quality/CostLow CostAverage CostHigh CostHigh Quality2.0x*1.0x*0.0%Average Quality1.0x*0.0%-0.5%Low Quality0.0%-0.5%-1.0%Optional Quality Tiering (2015)Maximum reduction is -1.0% for low quality and high cost

Payments are budget neutral; positive adjustment (x) will be after performance period ends (and CMS knows the total pool of available dollars to distribute)

Additional 1.0x for high risk patients (average beneficiary score in top 25%)High risk adjustment only applies if score is: High quality/low costHigh quality/average costAverage quality/low cost*Cells eligible for high risk bonus8889Timing of the 2015 VM9Sign up with CMS as a group practice by October 15, 2013Determine Quality Reporting Strategy for each TINFor 2013: submit quality data as group or sign up for administrative claims? What is long-term alignment with EHR reporting?Elect quality tiering (yes/no)?Download QRUR reports to understand current Cost and Quality scoresConsider implications of Physician Compare reporting

Additional resources on VM and GPRO:https://www.aamc.org/initiatives/patientcare/patientcarequality/311244/physicianpaymentandquality.htmlhttps://www.facultypractice.org/10What do Practices Need to Do?10ItemGPRO Web RegistryEHRAdministrative ClaimsEffective Date2013 forward2013 forward2014 forward2013 only (CMS could extend after 2013)Measure selectionPre-determined (18 measures)Practice selects from available PQRS measures (at least 3 measures)Practice selects 9 measures for which their EHR is certifiedPre-determined (14 process measures and 3 outcomes)Submission ProcessXML Web Tool

Registry submits data on groups behalfEHR submissionGroups register but do not need to submit dataReporting requirementsPopulate data fields for the first 411 consecutively ranked and assigned beneficiaries in the order in which they appear in the group's sample

Report each measure for at least 80 percent of the group practice's Medicare Part B FFS patients seen during the reporting period to which the measure applies. Choose 9 measures from 3 domains

Cannot report zero denominators for EHR group reporting

Claims data is used to evaluate performance on 14 quality measures and 3 outcome measures

Individual PQRS can also be appliedPublic Reporting of 2013 Performance Data2013 performance data and patient experience (CG-CAHPS) publicly reported on Physician CompareNo public reportingN/ANo public reportingAssignment of Patients/Beneficiaries CMS assigns using2-step primary care attributionRegistry/groups identify the patients based on measure specificationsEHR identifies patients based on measure specificationsCMS determinesQualifies for EHR Clinical Quality Measures (CQM)Yes (starting in 2014) if using CEHRTNoYes (starting in 2014)NoEffect on Incentives and Penalties(Incentives require successful reporting)Avoids the 2015 VM penaltyQualifies for 2013 and 2014 PQRS incentiveAvoids the 2015 VM penaltyQualifies for 2013 and 2014 PQRS incentiveAvoids the VM penalty starting in 2016Qualifies for 2014 PQRS incentiveAvoid the 2015 VM penaltyNo PQRS incentivesAppendix: GPRO Reporting Options for Large Groups111111