Physician Quality and Resource Use Reports

The Centers for Medicare and Medicaid Services (CMS) issued Medlearn Matters article SE1507 entitled, Physician Feedback, Quality and Resource Use Reports (QRURs) and Value-Based Modifier Program Overview & Implementation.

CMS is providing guidance on the Physician Feedback and Value-Based Modifier Program. Under the Value Modifier (VM) Program, performance on quality and cost measures can translate into payment incentives for providers who provide high quality, efficient care, while providers who underperform may be subject to a downward adjustment.

Eligible providers (EP) include: physicians and non-physician practitioners (nurse practitioners, physician assistants and clinical nurse specialists), occupational therapists, physical therapists, speech-language pathologists and audiologists submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Beginning Jan. 1, 2015, CMS began applying a VM to physician payments under the Medicare Physician Fee Schedule for physicians in groups with 100 or more EPs based on the 2013 performance period. The program will continue to be phased in according to the following schedule:

In 2016, the payment adjustments will apply to physicians in groups of 10 or more EPs based on 2014 performance;
in 2017, the payment adjustments will apply to physician solo practitioners and physicians in groups of 2 or more EPs based on 2015 performance; and
beginning 2018, the payment adjustments will also apply to non-physician EPs who are solo practitioners or are in groups of 2 or more EPs.

CMS recommends that EPs participate in the Physician Quality Reporting System (PQRS) in order to avoid automatic downward payment adjustments. The data reported to PQRS for a given calendar year are used to calculate the VM for the calendar year that follows it by 2 years. For example, PQRS quality data for Calendar Year 2013 were used to calculate the VM affecting payments in 2015.

For more details, please be sure to refer to the article above. Providers should also be sure to share this information with EPs in their organizations.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827