2016 QRUR and 2018 Value Modifier
Guidance for Merit-based Incentive Payment System (MIPS) under the Quality Payment Program replacement of the Value Modifier program.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: July 26, 2019
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.
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 showed 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 were identified in the QRURs by their Medicare-enrolled Taxpayer Identification Number (TIN). The 2018 Value Modifier payment adjustments shown in the 2016 Annual QRURs were based on policies finalized in the 2018 Medicare Physician Fee Schedule Final Rule (82 FR 53227-53232).
The informal review request for the 2018 Value Modifier has closed; therefore, a practice can no longer request an informal review of its 2018 Value Modifier payment adjustment.
The 2016 Annual QRURs showed how groups and solo practitioners performed on quality and cost measures relative to national benchmarks and indicated if physicians, PAs, NPs, CNSs, and CRNAs received an upward, neutral or downward Value Modifier adjustment to their payments for items and services rendered under the Medicare Physician Fee Schedule (Medicare PFS) in 2018. The QRURs also contained important information about care delivered to Medicare beneficiaries that could be used to better understand quality and cost performance and that could be used to improve quality and better coordinate care, including information about the hospitals and other providers that saw your patients.
2018 Value Modifier Program Experience Report
2018 Value Modifier Program Experience Report (PDF)
The 2018 Value Modifier Program Experience Report highlights characteristics of the practices subject to the Value Modifier in 2018 and compares program results across Calendar years 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 was applied to groups and solo practitioners that received an upward payment adjustment in 2018. The payment adjustment factor in 2018 was +6.6%.
Detailed Methodology for the 2018 Value Modifier and 2016 Quality and Resource Use Report (PDF)
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)
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)
2018 Value Modifier Informal Review Request Quick Reference Guide (condensed version) (PDF)
These documents illustrate how groups and solo practitioners that were subject to the 2018 Value Modifier could have submitted a 2018 Value Modifier Informal Review Request and how groups and solo practitioners could have modified or cancelled existing Value Modifier informal review requests.
2018 Value Modifier Informal Reviews Frequently Asked Questions" > 2018 Value Modifier Informal Reviews Frequently Asked Questions (PDF)
This document presents frequently asked questions (FAQs) and answers that groups and solo practitioners may have had about submitting a 2018 Value Modifier Informal Review.
Questions and Answers About the 2016 QRURs and 2018 Value Modifier (PDF)
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.
This guide describes the interactions between the Medicare Shared Savings Program and the 2018 Value Modifier.
Performance Year 2016 Prior Year Benchmark
" > Performance Year 2016 Prior Year Benchmark (PDF)The quality benchmarks shown in this document are the means and standard deviations for each measure that were included in the Performance Calendar 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 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.
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)
This document provides an overview of how the 2018 Value Modifier was calculated.
Sample 2016 Annual QRUR (Medical Practice A) (PDF)
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)
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.
This folder contains the templates for the tables that are included with the 2016 Annual QRURs. The templates are provided in Excel and Comma Separated Values format.
" > 2016 Annual QRUR Data Dictionary (ZIP)
This is a data dictionary that supports the Comma Separated Values 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)
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)
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)
This document provides an overview of the risk adjustment methodology used in the 2018 Value Modifier.
This document provides a detailed, methodological overview of the 30-Day All-Cause Hospital Readmission measure, calculated for the 2018 Value Modifier.
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)
This document provides a detailed, methodological overview of the Medicare Spending Per Beneficiary measure, calculated for the 2018 Value Modifier.
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)
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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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.