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Transcript of CMS VBP
Year 2016 (Performance year 2014)
General Overview - May 2014
Michelle Koltov, MPH
Associate, Health Policy and Regulatory Affairs
Overview of 2014 CMS Value Based Payment Program
Link with the Physician Quality Reporting System (PQRS)
Overview Quality Tiering using Quality and Cost Composites
2014 VBP Deadlines and what your practice needs to be aware of
What is the Value Based
Payment (VBP) Program?
The VBP assesses both
of care furnished and the
of that care under the Medicare Physician Fee Schedule. It is intended to provide comparative performance information to physicians.
The Affordable Care Act (ACA) mandates that the VBP program be implemented by 2017 in a budget neutral manner.
What is the VBP Program?
CMS VBP modifier applies to physician payment in groups of
10 or more eligible professionals (EPs).
The payment adjustment, which will be implemented on January 1, 2016, is based on 2014 performance period.
Groups of physicians are defined by a single Tax Identification Number (TIN).
Who does the VBP impact?
CMS Group size determination:
Step 1: Query Medicare’s Provider Enrollment, Chain and Ownership System (PECOS) to identify groups of physicians with 10+ EPs within 10 days of the close of the PQRS self-nomination process (September 30, 2014)
Step 2: CMS will remove groups from the list if the group did not have 10+ EPs that billed under the group’s TIN during 2014.
Who does the VBP impact?
How are VBP and PQRS linked?
CMS aligned these two programs to ease the reporting burden on physician practices.
Groups of physicians with 10+ EPs will be separated into two categories
based on PQRS reporting
Practices must meet the reporting criteria to avoid the 2016 PQRS payment adjustment to also avoid the VBP modifier payment adjustment
VBP and PQRS
Mandatory Quality tiering
Groups of 10-99 EPs: upward or no adjustment based on quality tiering
Groups of 100 or more EPs: upward, neutral, or downward payment adjustment based on quality tiering
-2.0% (downward adjustment)
This is in addition to the -2.0% adjustment under PQRS requirements
Groups with > 10 eligible professionals in 2014
VPB 2016 program year & PQRS
Measures reported through the PQRS (either as a group or individually)
Three outcome measures:
All Cause Readmission
Composite of Acute Prevention Quality Indicators (bacterial pneumonia, urinary tract infection, dehydration)
Composite of Chronic Prevention Quality Indicators (COPD, heart failure, diabetes)
PQRS CAHPS Measures for 2014 (Optional)
Patient Experience of Care measures
For groups of 25 or more eligible professionals
VBP Quality Measures
VBP Cost Measures
Total per capita costs measure (annual payment standardized and risk-adjusted Part A and Part B costs)
Total per capita costs for beneficiaries with four chronic conditions: COPD, Heart Failure, Coronary Artery Disease, Diabetes
Medicare Spending Per Beneficiary measure (includes Part A and B costs during the 3 days before and 30 days after an inpatient hospitalization)
What is the Quality-Tiering
*Eligible for an additional +1.0% if reporting clinical data for quality measures and average beneficiary risk score is in the top 25 percent of all beneficiary risk score.
Each group receives two composite scores (quality and cost), based on the group’s standardized performance. In order to achieve the legislatively mandated budget neutrality of the program, positive adjustments will be offset by negative adjustments to other groups based on the following table ...
Quality Tiering Methodology
Groups of 100 or more EPs will be subject to an
upward, neutral, or downward adjustment
based on quality-tiering.
Groups of 10-99 EPs will be subject
only to a upward or neutral adjustment
based on quality-tiering. These groups will be “held harmless” from the downward adjustment since this is their first year in the VBP program.
Mandatory Quality Tiering
A Quality Resource Use Report (QRUR), or a Physician Feedback Report, is a confidential report about the quality and costs of care that a physician provided to fee-for-service Medicare patients during the performance year. The report displays information on how quality and costs compare to averages from other physicians.
Quality Resource Use Reports
What does your practice
need to do?
Update information in PECOS – CMS will use this to determine practice size
September 30, 2014
is the deadline to use the PV-PQRS Registration System to self nominate a reporting method for PQRS
Ensure practice has an active IACS account
Participate in PQRS during calendar year 2014
January 1, 2016 the VBP modifier is applied
What does your practice need to do?
Groups of 10 or more EPs
Quality Resource and Use Reports (QRURs) will be available for all groups and solo practitioners during late summer 2014. These reports will include drill down tables including beneficiaries attributed to the group, their resource use, and specific chronic diseases.
Although groups of 10 or less will not be subject to the VBP during 2014, they are encouraged to review their QRUR to plan ahead for future years of the VBP program.
What does your practice need to do?
ACP’s Physician and Practice Timeline at http://www.acponline.org/running_practice/physician_practice_timeline/
Visit the CMS website at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/index.html
Access QRURs at https://portal.cms.gov
For more information …
April 1 - September 30, 2014:
Group Registration for PQRS reporting option using the PV-PQRS Registration System
January 1, 2015:
VBP modifier applied to all physician payments in groups of 100 or more (from 2013 performance year)
January 1, 2016:
VBP modifier applied to all physician payments in groups of 10 or more EPs (based on 2014 performance year)
Late Summer 2014:
QRURs available to all groups and solo practitioners. The 2013 QRURs will allow practices to preview value-modifier quality and cost composites.
Before September 30:
Ensure practice information in PECOS is up to date and make sure your practice has an "Individuals Authorized Access to CMS Computer Services (IACS)" account.
Practices have 2 main options ...
Practices must self nominate for
reporting via GPRO web-interface, registries, or EHR to avoid the VBP payment adjustment by September 30, 2014.
Using the PV-PQRS Registration System. Groups will need an IACS account to access this system.
If a group does not choose a group reporting options, CMS will look to see if at least 50% of a practice's EPs successfully report PQRS
. CMS will then combine the individual performance scores to get a group score to be used in the VBP program.
VBP/PQRS Reporting Options
CMS places each quality measure that the group has reported into one of the 6 quality domains above and the cost measures into the cost domains. A standard score for each measure is calculated by comparing the group's performance to the national mean. CMS then equally weighs all measures within a domain, then equally weighs all domains, to come up with a composite score
– self-nominate for GPRO web-interface, registries, or EHR OR 50% threshold AND avoid the 2016 payment adjustment criteria under PQRS
– do not self-nominate for PQRS OR meet 50% threshold AND do not avoid the 2016 payment adjustment under PQRS
Practice's composite scores will determine where a practice falls in the grid. The best place to be is in the top left hand corner - high quality and low cost - and the worst place to be is the bottom right corner - low quality and high cost. These practices will receive a -2% payment adjustment in 2016.
CMS will determine the specific upward payment adjustment based on the total sum of downward adjustments.
The 2013 Reports will be available for all groups and solo practitioners to download during late summer 2014.
CMS has already finalized that 2015 will serve as the performance year for the 2017 VBP program. ACP encourages all practices to review their QRUR report to plan for future years of the program.
Timeline of the VBP Program 2014-2016
Quality and Cost Measures are used to calculate composite scores which are used in quality-tiering. Quality-tiering is used to determine the VBP modifier that will impact physician payments in 2016. We'll now go through the measures used for the VBP ...