Supporting Quality and Efficiency in Medicare With Value-Based Payment Modification and Physician Feedback Reports

Prepared for
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services
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The Centers for Medicare & Medicaid Services (CMS) Physician Value program provides comparative quality and resource use performance information to medical group practices and physicians. The program is part of Medicare’s efforts to improve the quality and efficiency of medical care, and to develop and apply a value-based payment modifier (VM) as directed under the Affordable Care Act to all physicians’ Medicare fee-for-service reimbursements by 2017. The VM will pay physicians differentially based on a composite measure of the quality and cost of care furnished to Medicare beneficiaries.

To support CMS’s efforts to enhance the value of health care services provided to Medicare beneficiaries, Mathematica worked with Northrop Grumman to accomplish the following:

  • Provide technical support to CMS in the development and implementation of a VM
  • Conduct research analyses on topics such as risk-adjustment and the application of attribution and benchmarking rules
  • Support performance measure development and endorsement activities
  • Respond to inquiries from recipients of report

Since 2008, Mathematica has assisted CMS with phasing in the design, development, production, and dissemination of physician feedback reports, known as quality and resource use reports (QRURs). We have also assisted CMS with scaling up report dissemination and increasing the number of provider performance measures included in the reports, such as per capita and episode costs, Physician Quality Reporting System and claims-based quality, and other quality measures.

We have conducted extensive formative field research with physicians for the QRURs initially distributed to a few hundred physicians. In 2016, we produced and disseminated 313,319 QRURs and computed value-based payment adjustments for physicians in 208,832 medical groups and solo practices.