2014 QRUR and 2016 Value Modifier

Note: Calendar Year 2018 (2018) was the final payment adjustment period under the Value-Based Payment Modifier (Value Modifier) based on performance in Calendar Year 2016 (2016). Therefore, the Quality and Resource Use Reports (QRURs) are no longer available after December 31, 2018.

The Merit-based Incentive Payment System (MIPS) under the Quality Payment Program has replaced the Value Modifier program. The Centers for Medicare & Medicaid Services (CMS) encourages everyone to learn more about the Quality Payment Program by visiting https://qpp.cms.gov/. Please note that the QRURs are not the same as the MIPS Performance Feedback available under the Quality Payment Program.

For questions about the Value Modifier or the Quality Payment Program, contact the Quality Payment Program Service Center by phone at 1-866-288-8292 or by email at QPP@cms.hhs.gov. The Service Center is available Monday – Friday; 8:00 A.M. – 8:00 P.M. Eastern Time Zone.

The information below is for historical purposes only.

2014 QRURs

CMS made available two types of QRURs for Calendar Year 2014 (2014): the Mid-Year QRUR  and the Annual QRUR. This page contains links to templates, methodologies and supporting information for the Mid-Year QRUR 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 QRURs to every group practice and solo practitioner nationwide. Groups and solo practitioners were identified in the QRURs by their Medicare-enrolled Taxpayer Identification Number (TIN). The QRURs were 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 (CPC) initiative in 2014, and to those TINs that consisted only of non-physician eligible professional (EPs). The 2014 Annual QRURs showed 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 were subject to the 2016 Value Modifier, the QRUR showed how the Value Modifier was applied to physician payments under the Medicare Physician Fee Schedule (Medicare PFS) for physicians who billed under the group’s TIN in 2016. For all other groups and solo practitioners, the QRUR was for informational purposes only and did not affect their payments under the Medicare PFS in 2016.

The informal review period for the 2016 Value Modifier has closed; therefore, a practice can no longer request an informal review of its 2016 Value Modifier payment adjustment.

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)

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)

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)

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 Calendar Year 2013 (2013) QRURs and 2014 Annual QRURs.  

2016 Value Modifier Informal Review Request Quick Reference Guide (PDF)

This document illustrates how groups with 10 or more EPs that were subject to the 2016 Value Modifier could have submitted a 2016 Value Modifier Informal Review Request and how groups with 10 or more EPs could have modified or cancelled existing Value Modifier informal review requests.

Sample 2014 Annual QRUR (PDF)

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)

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

2014 Annual QRUR Data Dictionary (ZIP)

If you chose to download the 2014 Annual QRUR CSV file that was 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)  

This document provides an overview of how the 2016 Value Modifier was calculated.

Fact Sheet for Attribution in the Value-Based Payment Modifier Program (PDF)  

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

Fact Sheet for Specialty Adjustment in the Value-Based Payment Modifier Program (PDF)  

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

Fact Sheet for Risk Adjustment in the Value-Based Payment Modifier Program (PDF)  

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

Measure Information Form: Ambulatory Care-Sensitive Condition (ACSC) Composite Measures (PDF)  

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

Measure information Form: All Cause Hospital Readmission (PDF)  

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

Measure Information Form: Overall Total Per Capita Cost Measure (PDF)  

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

Measure Information Form: Condition-Specific Total Per Capita Cost Measures (PDF)  

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

Medicare Spending Per Beneficiary Measure (PDF)  

This document provides a detailed, methodological overview of the Medicare Spending per Beneficiary Measure, calculated for the Value 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 was applied to physician groups that were 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)  

Physician Value-Based Payment Modifier 2016 X-Factor Calculation (PDF)  

2014 Value Modifier Public Use Files

In May 2017, CMS made available de-identified Public Use Files, which contain data about physician groups subject to the Value Modifier in 2016.  The information provides the Value Modifier quality and cost tiers along with the payment adjustments for each physician group.

2016 Value Modifier Experience Report

The 2016 Value Modifier Program Experience Report (PDF)   provides summary data on the characteristics and performance of physician groups of 10 or more EPs subject to the Value Modifier in 2016 based on their 2014 quality and cost performance.  The report includes descriptive characteristics of all practices subject to the 2016 Value Modifier, their 2014 quality and cost measure performance, quality-tiering and payment adjustment category, quality reporting method, and performance by physician specialty.  The report also summarizes information for all group and solo practices that received a 2014 Quality and Resource Use Report (QRUR). 

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 were included in the Performance Year 2014 QRURs and used in the calculation of the 2016 Value Modifier. The benchmarks for each quality measure were 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 was part of the overall quality composite for the Value Modifier depended 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 compared to the mean for all solo practices and groups nationwide.

Performance Year 2014 Prior Year Benchmark (PDF)  

Means and Standard Deviations Used to Compute Quality and Cost Composite Scores for the Calendar Year 2015-2018 (PDF)  - 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. 

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

In April 2015, CMS made available the 2014 Mid-Year QRURs 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 TIN. Mid-Year QRURs provided interim information about performance on the six cost and three quality outcomes measures that we calculated directly from Medicare claims, based on care provided from July 1, 2013 through June 30, 2014. The Mid-Year QRUR did not affect a TIN’s payments under the Medicare PFS; rather, the Mid-Year QRURs were 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 was included in the Value Modifier. The Mid-Year QRURs were 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 Mid-Year QRURs did 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 Mid-Year QRURs:

Questions and Answers about the 2014 Mid-Year and Annual Quality and Resource Use Reports (PDF)

This document presents 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)

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)

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 were shown in the Mid-Year QRURs.

Sample 2014 MYQRUR Supplementary exhibits (ZIP)

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)

If you chose to download the Mid-Year QRUR CSV file that was 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.