The 2014 Annual Quality and Resource Use Reports (QRURs) were recently made available for solo practitioners and group practices that submitted PQRS measures in 2014. The 2014 Annual QRURs show providers how they performed in 2014 against the various quality and cost measures used to calculate Value-Based Payment Modifier (VBM) performance scores.
The VBM program adjusts payments up or down based on a physician’s performance on cost and quality measures (as opposed to PQRS, which just penalizes physicians for not reporting these measures). The Centers for Medicare & Medicaid Services (CMS) have been phasing in VBM by practice size. For the 2014 reporting year, the VBM applies to groups with 10 or more eligible professionals (EPs). For these groups, the QRUR is intended to show how the VBM will apply to physician payments under the Medicare Physician Fee Schedule in 2016. (For groups with fewer than 10 EPs and solo practitioners, the 2014 QRUR is informational only.)
NOTE: Due to a CMS systems error, CMS will modify its methodology for calculating composite quality and cost scores, relying on claims data for quality scoring and eliminating the “low” VBM quality score (CMS will instead assign an “average” quality tier). Therefore, there will be no negative VBM adjustment as long as cost scoring is “low” or “average”. The negative VBM adjustment would still apply for a score with a combination of “high” cost and “average” quality.
As they did with PQRS penalties, CMS also established a 60-day informal review period and a process to request a correction of a perceived error in 2016 Value Modifier calculations. (See here for more details.)
Impact for NextGen Healthcare Clients:
- Performance on these cost and quality performance measures is increasingly important due to the increasing percentage of Medicare payments tied to performance each year. Providers in groups of 10 or more should evaluate their QRUR reports so they can anticipate VBM payment adjustments to be applied starting January 1, 2016. Smaller groups should use this data to help them avoid future penalties, as the program will apply to all providers starting with the 2015 performance year.
- If you did not report 2014 measures as required, we urge you to take the necessary steps to do so for 2015 and avoid additional penalties.
- NextGen® Health Quality Measures (NextGen HQM) is available to all clients for reporting quality measures, including PQRS and MU clinical quality measures. To get NextGen HQM, simply open a support incident for “HQM install”.
- A complimentary “PQRS 101” webinar is available on Knowledge Exchange to help you get started with PQRS reporting. (Search for “PQRS 101”)
- NextGen® Physician Consulting Services offers individualized assistance with PQRS reporting and can help clients understand CMS’ scoring methodology under this program, improve their performance scores, and maximize their reimbursements (contact your NextGen Healthcare sales representative for information).