QRUR: Getting a Read on Your Value Modifier

“The benefit we have is that we can take the individual group’s performance data, aggregate it, and see if there are opportunities to learn from each other. That is happening already.”

Lisa Mead, RN, MS, CPHQ
Director, SR PSO Quality and Safety
December 20, 2017

On September 18, 2017, CMS made available the 2016 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner in the nation. SR Quality Director Lisa Mead took that one step further and provided those Strategic Radiology (SR) practices that submitted their data to SR’s Patient Safety Organization with an additional benchmarking document showing them how they compared with their SR peers.

“The benefit we have is that we can take the individual group’s performance data, aggregate it, and see if there are opportunities to learn from each other,” she explains. “That is happening already.”

The document provided to participating SR practices showed three years of quality and cost scores and whether or not a practice qualified for the high-risk bonus payment. Scores were also compiled for those practices that participate in an ACO.

Data were provided for each applicable quality measure, from 76 (CVC Insertion Protocol) to 436 (Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques), giving groups the opportunity to work together to improve reporting templates and develop approaches radiology education.

The QRURs provide the basis for each group’s Value Modifier (VM), a device introduced by the Affordable Care Act and based on the practice’s quality reporting and cost information gleaned from claims data. The VM based on the 2016 data will impact physician payment in 2018.

In 2018, the provider community expects to transition to the Merit-based Incentive Payment System, which will provide a final score based on four categories: quality, cost, practice improvement activities, and advancing care information. CMS made a last-minute decision to implement the cost category in the 2018 Medicare Physician Fee Schedule Final Rule released in November.

Widespread criticism of the complexity of MIPS make it likely that the program will be changed and possibly abandoned. We don’t know where MACRA or MIPS are going because MedPAC is making recommendations now and we won’t have them until March,” Mead explains. “The problem I have with scoring physicians based on the costs of patients that are attributed to them is that the practices haven’t figured out how to manage those costs.”

 Mead noted that this is a particularly challenging task for neurointerventional radiologists.

“The biggest takeaway is no matter what happens, quality and cost are big focus for Medicare and the insurance plans,” Mead says. “There is a movement to go into APMs, the payers are expecting quality, and they are pushing more risk. If you are going to be a part of an ACO you need to know how you can help. If you are going to participate, you’ll need to be articulate about the measures if you want a piece of the contract.”

—Cheryl Proval

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