Your 2016 QRUR will be the last you ever receive Your 2016 QRUR will be the last you ever receive

Your 2016 QRUR will be the last you ever receive

You should now have access to your 2016 annual Quality and Resource Use Report (QRUR), which describes your practice’s cost performance in 2016 and your payment adjustment for 2018 under the Value-Based Payment Modifier (VBM) program. This will be the last QRUR you receive because the VBM program will go away in 2018, replaced by the Cost performance category of the Merit-based Incentive Payment System (MIPS).

The Cost performance category will account for 10% of your overall MIPS score during the 2018 measurement year (see related story, pg. 6), which will be used to set your MIPS payment adjustment in 2020. Remember: To access your QRUR, you will need to log into the CMS Enterprise Portal at https://portal.cms.gov/wps/portal/unauthportal/home/.

The QRUR determines your 2018 value modifier based on quality and cost. In the case of Colorado ENT & Allergy in Colorado Springs, the group was determined to have shown “high” quality and “average” cost in 2016, says Kevin Watson, administrator. This resulted in a +1.0x adjustment factor for 2018, which is the same adjustment factor his practice received in 2016 based on their 2014 performance. In 2016, that adjustment factor resulted in a Part B payment boost of approximately 16%, and Watson expects a similar bonus in 2018.

Because the value modifier is based on quality and cost data that CMS automatically calculates, and because those variables do not factor in provider specialty, Watson argues that practices can do little to boost their QRUR ratings.

In the case of many specialties such as ENT or orthopedic surgery, many QRUR measures could be affected by variables that these specialists would have little control over. To measure cost, CMS assigns individuals Part B beneficiaries to providers based on whichever provider performed the majority of E/M services to each beneficiary each year. Thus if a specialist happens to perform the majority of a beneficiary’s E/M services in a year, he or she is on the hook for all of that beneficiary’s healthcare costs, even for conditions that are not managed by his or her specialty. This includes conditions such as coronary artery disease, diabetes, and hypertension, as well as any hospital admissions regardless of the reason.

Otolaryngologists are in a similar boat, Watson says. “CMS understands that this is not equitable to some specialties,” he says. “They admit it; they say they have to start somewhere. I guess we’ll see what happens with the cost component of MIPS once it comes online.”

Looking forward to MIPS

In the QRUR, a copy of which was obtained by The Business of Medicine, CMS advises practices to prepare for MIPS. “2018 will be the final year that Medicare will apply the Value Modifier to clinician payments for services billed under the Medicare Physician Fee Schedule,” the agency states. “In 2019, the Quality Payment Program (QPP) payment adjustment will be based on the 2017 performance year.”

Thus the bonus payments for recent years and going forward break down as follows:

  • 2016: Based on the various CMS quality reporting programs, including EHR meaningful use, the Physician Quality Reporting System (PQRS), and the value modifier (VBM) from 2014.
  • 2017: Same as above, except based on 2015 data.
  • 2018: Same as above, except based on 2016 data.
  • 2019: MIPS consolidates all of the previous quality reporting programs. A single MIPS composite score will determine Part B payment adjustment based on 2017 performance under the four MIPS components (quality, EHR meaningful use, clinical practice improvement, and cost).
  • 2020: Same as above, with MIPS payment adjustment based on 2018 MIPS performance.