1. QRUR and Value Modifier:
Medicare Physician Report Card and Pay-for Performance Program
AAMC Contact:
Mary Wheatley
August 2013

2. What are Quality Resource Use Reports (QRUR) and Value Modifier?
Medicare Report Card (confidential)
Quality and cost composite measures
Ranked “High”, “Average”, or “Low” for both cost and quality
Quality from Physician Quality Reporting System (PQRS) data submission and supplemental claims information
Cost data from claims
Value-Based Physician Modifier (VM)
Medicare Pay-For-Performance Program
Use scores from QRUR to adjust payment upward or downward
Adjustments start in 2015 for some practices; 2017 for all physicians and physician groups
QRUR Report cards, based on 2012 data, expected mid-September 2013 for groups with 25 or more professionals 2

3. Process to Determine QRUR and VM
Inputs
Groups decide which PQRS/quality reporting to choose. Automatic penalty for not submitting PQRS data.
Non-PQRS Outcome Measures (from claims)
PQRS
Data
Cost Measures (from claims) +
Calculation
CMS Calculates Quality and Cost Composite Scores
Quality Composite Score
Cost Composite Score
Outputs
CMS releases report with benchmark data to groups.
Medicare Part B payments adjusted based on scores.
Private Feedback Report
Pay-for-Performance
Quality & Resource Use Reports (QRUR)
Payment Adjustment based on scores (Quality Tiering)
Gray - Data supplied by physician groups Green – Data supplied by CMS

4. 2015 VM Affects Most Large Group Practices
Group with ≥ 100 EPs/TIN in 2013?* NO
Excluded from 2015 VM Included in 2017 VM
* VM excludes groups participating in Pioneer or MSSP ACOs.
YES
2013 Group Reporting or Admin Claims?
-1.0% Penalty in 2015 NO
YES
Optional :
Quality Tiering
0.0% Penalty (No Adjustment) in 2015
Upward or Downward adjustment based on Cost and Quality Performance

5. Groups Must Choose PQRS Reporting Option
Large 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 Interface
Registry
Administrative claims (available for 2013)
EHR (starting in 2014)
(See appendix for more details) 5

6. VM - Quality and Cost Measures
Quality Measures
PQRS reported measures (varies by reporting method)
3 claims-based outcome measures
Acute prevention quality indicators composite
Chronic prevention quality indicators composite
All cause readmission
Cost Measures
Total cost per capita
Per capita costs for 4 condition populations
COPD
Heart Failure
Coronary Artery Disease
Diabetes
Cost measures risk-adjusted and price-standardized
Performance reported through Quality Resource Use Report (QRUR) 6

7. Value Modifier Composite
Quality and cost measures roll-up into domains. Each domain is weighted equally.

8. Optional Quality Tiering (2015)
Quality/Cost
Low Cost
Average Cost
High Cost
High Quality
2.0x*
1.0x*
0.0%
Average Quality
-0.5%
Low Quality
-1.0%
*Cells eligible for high risk bonus
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 cost
High quality/average cost
Average quality/low cost 8

9. Timing of the 2015 VM 9 2013 Cost and Quality Performance Period
Large groups (excluding ACOs) nominate themselves, submit quality data or choose administrative claims data BY OCTOBER 15
Option to elect quality tiering
2014
CMS calculates 2013 performance results
Fall 2014 – Quality Resource Utilization Reports (QRUR) based on 2013 data
2015
Adjustments for VM and PQRS applied 9

10. What do Practices Need to Do?
Sign up with CMS as a group practice by October 15, 2013
Determine Quality Reporting Strategy for each TIN
For 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 scores
Consider implications of Physician Compare reporting
Additional resources on VM and GPRO: 10

11. Appendix: GPRO Reporting Options for Large Groups
Item
GPRO Web
Registry
EHR
Administrative Claims
Effective Date
2013 forward
2014 forward
2013 only (CMS could extend after 2013)
Measure selection
Pre-determined (18 measures)
Practice selects from available PQRS measures (at least 3 measures)
Practice selects 9 measures for which their EHR is certified
Pre-determined (14 process measures and 3 outcomes)
Submission Process
XML Web Tool
Registry submits data on groups behalf
EHR submission
Groups register but do not need to submit data
Reporting requirements
Populate 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 applied
Public Reporting of 2013 Performance Data
2013 performance data and patient experience (CG-CAHPS) publicly reported on Physician Compare
No public reporting
N/A
Assignment of Patients/Beneficiaries
CMS assigns using
2-step primary care attribution
Registry/groups identify the patients based on measure specifications
EHR identifies patients based on measure specifications
CMS determines
Qualifies for EHR Clinical Quality Measures (CQM)
Yes (starting in 2014) if using CEHRT No
Yes (starting in 2014)
Effect on Incentives and Penalties
(Incentives require successful reporting)
Avoids the 2015 VM penalty
Qualifies for 2013 and 2014 PQRS incentive
Avoids the VM penalty starting in 2016
Qualifies for 2014 PQRS incentive
Avoid the 2015 VM penalty
No PQRS incentives 11