Medicare: Medicare FFS Physician Feedback Program/Value-Based Payment Modifier: 2013 QRUR and 2015 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 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.

2013 Quality and Resource Use Report

In September 2014, CMS made available QRURs to all groups and physician solo practitioners nationwide who met two criteria: (1) at least one physician billed under the Medicare-enrolled Taxpayer Identification (TIN) in Calendar Year 2013 (2013), and (2) the TIN had at least one eligible case for at least one of the quality or cost measures included in the QRUR. CMS did not disseminate 2013 QRURs to group practices or solo practitioners participating in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, and the Comprehensive Primary Care (CPC) Initiative.

The following documents supplement and provide detailed information to accompany the 2013 QRURs:

Tips to Understand and Use the 2013 Quality and Resource Use Report (QRUR) and QRUR Supplementary Exhibits (PDF) - This document provides tips on how physicians and groups of physicians can use the 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.

Questions & Answers About the 2013 Quality and Resource Use Reports (PDF) - This document presents frequently asked questions (FAQs) and answers that physicians and groups of physicians may have about the 2013 QRURs and the Value Modifier.

Detailed Methodology for the 2013 Quality and Resource Use Reports and 2015 Value-Based Payment Modifier (PDF) - This document provides details of the technical methodology used to produce the 2013 QRURs.

Means and Standard Deviations For Measures Included In The 2013 Quality And Resource Use Reports (QRUR) (PDF) - This document presents the benchmark means and standard deviations for all quality and cost measures included in the 2013 QRUR, by reporting mechanism and TIN size, that were used to calculate value-based performance in Calendar Year 2015 (2015). The document also includes further information on 2013 performance that reflects revisions that were applied to the calculation of value-based performance in 2016 (for which the period of performance was Calendar Year 2014 (2014).

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.

Changes to the Quality and Resource Use Reports from Performance Year 2012 to Performance Year 2013 (PDF) - This document provides an overview and enumerates changes in the format and content of the QRUR between Calendar Year 2012 (2012) and 2013. Many changes are the result of feedback and suggestions received by CMS.

Sample 2013 Quality and Resource Use Report (PDF) - This document represents a sample 2013 QRUR for a group with 100 or more eligible professionals (EPs) that elected quality-tiering and for which CMS was able to calculate quality and cost composite scores. This document shows all of the exhibits that were shown in the QRUR.

Sample 2013 QRUR Drill Down Tables (ZIP) - This spreadsheet contains the templates for the six supplementary exhibits that provide detailed information to accompany the 2013 QRURs.

Ambulatory Care Sensitive Condition (ACSC) Measures and the All-Cause Hospital Inpatient Readmission Measure Included in the 2013 Quality and Resource Use Reports (PDF) - This document presents the specifications for the Ambulatory Care Sensitive Conditions (ACSCs) measures, as well as the all-cause inpatient hospital readmissions measure.  The hospital admission rates for the ACSC measures and the readmissions measure are calculated from 2013 Medicare Part A claims data.  ACSCs are conditions for which good outpatient care can prevent complications or more serious disease. The Agency for Healthcare Research and Quality (AHRQ) developed measures of potentially avoidable hospitalizations for ACSCs as part of a larger set of Prevention Quality Indicators (PQIs).  The QRUR presents six individual measure rates (for bacterial pneumonia, urinary tract infection, dehydration, diabetes, chronic obstructive pulmonary disease or asthma, and heart failure) as well as rates for two composite measures that are calculated using the individual measure rates. Only the composites, and not the individual measure rates, are used in the Value Modifier.

The risk-adjusted all-cause readmissions measure is a physician group and solo practice-specific, all-cause 30-day rate of acute care hospital readmissions (defined as an unplanned readmission for any cause within 30 days from the date of discharge of an index admission in 2013) for beneficiaries 65 years or older from an acute care or critical access hospital.

Administrative Claims-Based Quality Measures Included in the 2013 Quality and Resource Use Reports (PDF) - This document contains narrative specifications for the 14 Physician Quality Reporting System (PQRS) administrative claims-based quality measures included in the 2013 Quality and Resource Use Reports. These claims-based quality measures reflect the most current measure specifications. The specifications are the same as those for the endorsed versions of these measures, except when prevented by the structure of Medicare data or by the availability of data for the 2013 Quality and Resource Use Reports.  Deviations from the endorsed specifications are described in the table’s endnotes. The claims-based quality measures are used to assess the quality of care provided by groups who are not participating in the PQRS Group Practice Option.

Drug List for “Use Of High Risk Medications in the Elderly” Measure in the 2013 Quality and Resource Use Reports (PDF) - The "Use of High Risk Medications in the Elderly" measure is one of the 14 PQRS administrative claims-based quality measures included in the 2013 QRUR.  This document presents the medication list for this composite measure that is based on two of the claims-based quality measures: the "Patients Who Receive At Least One Drug to Be Avoided" measure and the "Patients Who Receive At Least Two Different Drugs to Be Avoided" measure.

Summary of 2015 Physician Value-based Payment Modifier Policies (PDF)  

The 2015 Value Modifier Results

We display the results of the 2015 Value Modifier in the "2015 Value Modifier Results (PDF)" document.  This document gives the adjustment factor for 2015 payment adjustments for physicians in groups with 100 or more EPs and shows information on the number of those groups subject to the 2015 Value Modifier.

2013 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 2015. The information provides the Value Modifier quality and cost tiers along with the payment adjustments for each physician group.

2015 Value Modifier Program Experience Report (PDF)

The 2015 Value Modifier Program Experience Report summarizes data on the characteristics and performance of the physician groups subject to the Value Modifier in 2015.  Some of the information included in this report includes:

• Descriptive characteristics of the physician groups that were subject to the 2015 Value Modifier and the subset of the groups whose Value Modifier was based on their 2013 quality and cost performance under quality-tiering, and also the characteristics of the physician groups and physician solo practitioners that received a 2013 Quality and QRUR (Section III).
• Analysis of the characteristics of physician groups subject to quality-tiering by their payment adjustment category and performance on the Quality and Cost Composites for the 2015 Value Modifier (Section IV).

Quality Benchmarks for the 2015 Value Modifier and the 2013 Quality and Resource Use Reports

The quality benchmarks shown in this document are the means for each measure that were included in the Performance Year 2013 QRURs and used in the calculation of the 2015 Value Modifier. The benchmarks for each quality measure were based on the performance of all solo practitioners and groups nationwide in 2012, the year prior to the performance year (2012 benchmarks for the 2013 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 2013 Prior Year Benchmark (PDF)