2015 QRUR and 2017 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.

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 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 made available the 2015 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 initiative in 2015, in addition to those TINs consisting only of non-physician eligible professional (EPs). The 2015 Annual QRURs showed 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 were subject to the 2017 Value Modifier, the QRUR showed how the Value Modifier was applied to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who billed under the TIN in 2017.

The informal review period for the 2017 Value Modifier has closed; therefore, a practice can no longer request an informal review of its 2017 Value Modifier payment adjustment.

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)  

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)  

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)  

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  (PDF)

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

Medicare Shared Savings Program Interaction with the 2017 Value Modifier Frequently Asked Questions (PDF)  

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)  

This document illustrates how groups and solo practitioners that were subject to the 2017 Value Modifier could have submitted a 2017 Value Modifier Informal Review Request and how groups and solo practitioners could have modified or cancelled existing Value Modifier informal review requests.

Sample 2015 Annual QRUR (Medical Practice A) (PDF)

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)  

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)  

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)  

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)  

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)  

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)  

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)  

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)  

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)  

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)  

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)   

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 applied 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 was applied to physician groups and physician solo practitioners that received an upward payment adjustment in 2017. Physician group practices with 2 or more eligible professionals and physician solo practitioners were subject to the 2017 Value Modifier quality-tiering methodology.

Physician Value-Based Payment Modifier 2017 Adjustment Factor Calculation (PDF)

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 (PDF)

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)   

This document describes the action physician groups with 2 or more eligible professionals and physician solo practitioners needed 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.

2015 Value Modifier Public Use Files

CMS released de-identified Public Use Files, which contain data about physician groups and solo practitioners subject to the 2017 Value Modifier. The information provides the 2017 Value Modifier quality and cost tiers along with the payment adjustments for each physician group and solo practitioner based on their performance in 2015.

2017 Value Modifier Program Experience Report

The 2017 Value Modifier Program Experience Report (PDF)  provides summary data on the characteristics and performance of physician solo practitioners and those in groups of 2 or more eligible professionals subject to the Value Modifier in 2017 based on their 2015 quality and cost performance. The report includes descriptive characteristics of all practices subject to the 2017 Value Modifier, their 2015 quality and cost measure performance, quality-tiering and payment adjustment category, quality reporting method, and performance by physician specialty.

Quality Benchmarks for the 2017 Value Modifier and the 2015 Annual QRURs - Updated 6/15/16 (PDF)  

The quality benchmarks shown in this document are the means and standard deviations for each measure that were included in the Performance Year 2015 Annual QRURs and used in the calculation of the 2017 Value Modifier. The benchmarks for each quality measure were 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 was part of the overall quality composite for the Value Modifier depended 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 compared 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)  

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.

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 differed from the actual performance period used for the 2017 Value Modifier, which extended from January 1, 2015 through December 31, 2015. The Mid-Year QRUR report was provided for informational purposes only and did not affect a TIN’s Medicare Physician Fee Schedule payments.

The 2015 Mid-Year QRUR provided interim information about a TIN’s performance on the six cost measures and three claims-based quality outcome measures that were a subset of the measures that were used to calculate the 2017 Value Modifier. This report did 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 have been different between a TIN’s 2015 Mid-Year QRUR and the 2015 Annual QRUR. The 2015 Annual QRUR was made available in Fall 2016 and showed a TIN’s actual performance on all of the quality measures and cost measures that were used to calculate the 2017 Value Modifier.

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

How to Understand Your 2015 Mid-Year QRUR (PDF)  
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)  

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 were shown in the 2015 Mid-Year QRUR.

Sample 2015 Mid-Year QRUR Tables (ZIP)  

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)  

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