An Overview Understanding the Value-Based Payment Modifier (VM)

• The New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO) is administered by Healthcentric Advisors in partnership with Qualidigm. Together, they serve as the QIN-QIO for all six New England states.

• CSMS is assisting the New England QIN-QIO in developing and disseminating information about Medicare quality programs.

In Context

In Context

Medicare Quality Programs

PQRS: Physician Quality Reporting System

• A pay-for-reporting program that gives eligible professionals (EPs) incentives and payment adjustments for satisfactory reporting of quality measures

• Physician participation helps improve the quality of care

• Satisfactory reporting of 2015 data will avoid 2017 Payment Adjustments for PQRS and the Value Modifier (VM)

Value-Based Payment Modifier (VM)

• The VM is a payment differential applied to Medicare FFS payments

• It is based on the quality and cost of care provided to Medicare beneficiaries by Eligible Professionals (EPs)

• The VM uses cost and quality data to assign quality tiers: upward, neutral, or downward

• There is a 2-year lag between reporting data and payment adjustments:

– 2014 cost and quality data will affect the VM for 2016 Medicare FFS payments

– 2015 cost and quality data will affect the VM for 2017 Medicare FFS payments

Quality Tiering Data: AQRUR

The Annual Quality and Resource Use Report is a component of the Value Based Payment Modifier program (VM).

It provides data on quality of care and the resources used to provide that care to Medicare FFS beneficiaries.

An Enterprise Identity Data Management (EIDM) account is needed to obtain your AQRUR.

Quality Tiering Data: AQRUR

An AQRUR is provided for each TIN

AQRUR data includes:

• Quality and cost measures

• VM calculation for groups of 10+ EPs*

• Quality tier designation (high, average, low), and

• Benchmark data for peer comparisons

*For groups of 1 – 9 EPs, the 2014 AQRUR is informational only – no payment adjustments for 2016

Eligible Professionals (EPs) CMS recognizes 3 types of EP

Medicare Physicians Practitioners Therapists

Doctor of Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Optometry Doctor of Oral Surgery Doctor of Dental Medicine Doctor of Chiropractic

Physician Assistant Nurse Practitioner* Clinical Nurse Specialist* Certified Registered Nurse Anesthetist* (and Anesthesiologist Assistant) Certified Nurse Midwife* Clinical Social Worker Clinical Psychologist Registered Dietician Nutrition Professional Audiologists *Includes Advanced Practice Registered Nurse (APRN)

Physical Therapist Occupational Therapist Qualified Speech-Language Therapist

Overview: VM Quality and Cost Composites

Value Composite Score Cost Composite Score

Any reported PQRS measures

Total Per Capita Costs for All Beneficiaries

Total Per Capita Costs for Select Conditions

Medicare Spending per Beneficiary

3 Claims-based Outcomes Measures

• All-Cause Readmissions • Acute Preventive Quality Indicator Composite • Chronic Preventive Quality Indicator Composite

2017 VM Adjustments for Solo and Small Group (2-9) EPs

Low Quality Average Quality High Quality

Low Cost 0.0% +1.0x* +2.0x*

Average Cost 0.0% 0.0% +1.0x*

High Cost 0.0% 0.0% 0.0%

*If the average beneficiary risk score is in the top 25%, EPs can receive an additional +1.0x adjustment

2017 VM Adjustments for Groups of 10+ EPs

Low Quality Average Quality High Quality

Low Cost 0.0% +2.0x* +4.0x*

Average Cost -2.0x 0.0% +2.0x*

High Cost -4.0x -2.0x 0.0%

*If the average beneficiary risk score is in the top 25%, EPs can receive an additional +1.0x adjustment

2017 VM Adjustment Factor

• Max +2.0x for solo, 2-9 EPs*

• Max +4.0x for 10+ EPs* Upward

• No adjustment Neutral

• Solo, 2-9 EPs held harmless

• Max -4.0x for 10+ EPs Downward

*If the average beneficiary risk score is in the top 25%, EPs can receive an additional +1.0x adjustment

Phasing in VM

• 2015 payments to groups of 100+ EPs are based on 2013 data

• 2016 payments to groups of 10-99 EPs will be based on 2014 data

• 2017 payments to solo and small group (2-9) EPs, as well as groups of 10+ EPs, will be based on 2015 data

In Context

The Big Picture

Medicare Payment Adjustment: The Big Picture

For solo EPs or groups of 2-9 EPs who successfully participate in PQRS and MU in 2015:

*Solo EPs & groups of 2-9 EPs will be held harmless from downward VM adjustments if they successfully participate in PQRS

**Amount depends on date of first demonstration of MU

PQRS

no downward payment

adjustment in 2017

VM * +2.0x or +1.0x or Neutral

in 2017

MU ** $4,000- $12,000

in 2017

Medicare Payment Adjustment: The Big Picture

For solo EPs or groups of 2-9 EPs who do not participate in PQRS or MU in 2015:

-7.0 % total Medicare payment adjustment in 2017

PQRS -2.0%

payment adjustment in

2017

VM -2.0x

payment adjustment in

2017

MU -3.0%

payment adjustment in

2017

Medicare Payment Adjustment: The Big Picture

For groups of 10+ EPs who successfully participate in PQRS and MU in 2015:

PQRS

no downward payment

adjustment in 2017

VM +4.0x or +2.0x or Neutral

in 2017

MU $4,000-

$12,000* in 2017

* Amount depends on date of first demonstration of MU

Medicare Payment Adjustment: The Big Picture

For groups of 10+ EPs who do not participate in PQRS or MU in 2015:

Up to -9.0 % Medicare payment adjustment in 2017

PQRS -2.0%

payment adjustment in

2017

VM Up to -4.0x

payment adjustment in

2017

MU -3.0%

payment adjustment in

2017

Medicare Payment Adjustment: Groups of 10+ EPs

Unsuccessful participation in PQRS, non-participation in MU in 2015:

Up to -9.0% Medicare payment adjustment in 2017

PQRS -2.0%

payment adjustment in

2017

VM Up to -4.0x

payment adjustment in

2017

MU -3.0%

payment adjustment in

2017

2015: It’s Not Too Late

Your 2014 AQRUR shows whether you will receive

a negative VM payment adjustment in 2016

2015: It’s Not Too Late

If you believe that you have been incorrectly assessed a 2016 PQRS or VM negative payment adjustment, you can request an informal CMS review of your incentive eligibility and/or payment adjustment determination.

The deadline to request an informal review has been extended to November 23, 2015.

2015: It’s Not Too Late

2015 PQRS data reporting doesn’t begin until February 2016

2014 AQRUR data can be used to identify opportunities for 2015 quality and cost improvement

VM Resources

CSMS provides regular updates on VM, QRUR, PQRS, and other Medicare quality programs: http://csms.org/Medicare

Value-Based Payment Modifier – CMS Main Page https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.html#Gradual%20Implementation%20of%20the%20Value%20Modifier

What to do in 2015 for the 2017 VM

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdf

Summary of Physician Value-Based Payment Modifier Policies

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdf

https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.htmlhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/What-To-Do-In-2015-For-The-2017-VM.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/CY2015ValueModifierPolicies.pdf

Additional Resources Getting Started with PQRS

http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/How_To_Get_Started.html

Obtaining an EIDM Account

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Guide-for-Obtaining-a-New-User-EIDM-Account-with-a-Physician-Quality-and-Value-Programs-Role.pdf

Requesting an Informal Review of 2016 Payment Adjustment https://www.qualitynet.org/portal/server.pt/community/pqri_home/212

QualityNet Help Desk

866-288-8912 or qnetsupport@hcqis.org. Available Monday – Friday, 7 am - 7 pm CT

Physician Value Help Desk (for VM questions)

888-734-6433 press 3. Available Monday – Friday, 8 am – 8 pm ET

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CSMS Webinar Series

Visit http://csms.org/webinars for free on-demand learning about the basics of Medicare quality programs:

• PQRS: An Overview

• Understanding MYQRUR

• Understanding AQRUR encore live presentation on 11/19

• Understanding VM

http://csms.org/webinars

Questions?

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Thank You!

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