AAMC Contact: Mary Wheatley mwheatley@aamc 202-862-6297 August 2013

1. QRUR and Value Modifier: Medicare Physician Report Card and Pay-for Performance Program AAMC Contact: Mary Wheatley mwheatley@aamc.org 202-862-6297 August 2013

2. What are Quality Resource Use Reports (QRUR) and Value Modifier? QRUR Report cards, based on 2012 data, expected mid-September 2013 for groups with 25 or more professionals 2

3. Process to Determine QRUR and VM Inputs Groups decide which PQRS/quality reporting to choose. Automatic penalty for not submitting PQRS data. Non-PQRS Outcome Measures (from claims) PQRS Data Cost Measures (from claims) + Calculation CMS Calculates Quality and Cost Composite Scores Cost Composite Score Quality Composite Score Outputs Private Feedback Report CMS releases report with benchmark data to groups. Medicare Part B payments adjusted based on scores. Pay-for-Performance Quality & Resource Use Reports (QRUR) Payment Adjustment based on scores (Quality Tiering) Gray - Data supplied by physician groups Green – Data supplied by CMS

4. 2015 VM Affects Most Large Group Practices Group with ≥ 100 EPs/TIN in 2013?* NO Excluded from 2015 VMIncluded in 2017 VM * VM excludes groups participating in Pioneer or MSSP ACOs. YES 2013 Group Reporting or Admin Claims? -1.0% Penalty in 2015 NO YES Optional : Quality Tiering 0.0% Penalty (No Adjustment) in 2015 Upward or Downward adjustment based on Cost and Quality Performance

5. Groups Must Choose PQRS Reporting Option • Large groups (100 or more eligible professionals) must report quality data as a group to avoid automatic VM cut • 2013: Possible +0.5% incentive for the Physician Quality Reporting System (PQRS) • 2015: Avoids additional -1.5% reduction for PQRS • Reporting options vary by the size of the group. For large groups, the choices are: • GPRO Web Interface • Registry • Administrative claims (available for 2013) • EHR (starting in 2014) (See appendix for more details) 5

6. VM - Quality and Cost Measures Quality Measures • PQRS reported measures (varies by reporting method) • 3 claims-based outcome measures • Acute prevention quality indicators composite • Chronic prevention quality indicators composite • All cause readmission Cost Measures • Total cost per capita • Per capita costs for 4 condition populations • COPD • Heart Failure • Coronary Artery Disease • Diabetes Cost measures risk-adjusted and price-standardized Performance reported through Quality Resource Use Report (QRUR) 6

7. Value Modifier Composite Quality and cost measures roll-up into domains. Each domain is weighted equally.

8. Optional Quality Tiering (2015) *Cells eligible for high risk bonus • Maximum reduction is -1.0% for low quality and high cost • Payments are budget neutral; positive adjustment (“x”) will be after performance period ends (and CMS knows the total pool of available dollars to distribute) • Additional “1.0x” for high risk patients (average beneficiary score in top 25%) • High risk adjustment only applies if score is: • High quality/low cost • High quality/average cost • Average quality/low cost 8

9. Timing of the 2015 VM 9

10. What do Practices Need to Do? • Sign up with CMS as a group practice by October 15, 2013 • Determine Quality Reporting Strategy for each TIN • For 2013: submit quality data as group or sign up for administrative claims? • What is long-term alignment with EHR reporting? • Elect quality tiering (yes/no)? • Download QRUR reports to understand current Cost and Quality scores • Consider implications of Physician Compare reporting • Additional resources on VM and GPRO: • https://www.aamc.org/initiatives/patientcare/patientcarequality/311244/physicianpaymentandquality.html • https://www.facultypractice.org/ 10

11. Appendix: GPRO Reporting Options for Large Groups 11