cost because that’s where the greatest reward
is going to be.
In your report, underneath the scatter plot
will be an explanation and it will talk about
high-risk bonus adjustment and I’ll give you an
example and in that particular example it’s not
eligible [Figure 10]. What this describes is what
your average benefciary risk is for your TIN and
a particular example that I’m referring to is the
77th percentile of benefciaries nationwide. Ten
what it explains is the Medicare determination
for your TIN’s eligibility for additional upward
adjustment for serving high-risk benefciary
based on whether your TIN met [ indicated with
checkmark] or did not meet [indicated with X]
the following criteria in 2014. In this particular
sample report, the TIN’s average benefciary risk
is at or above the 75th percentile so they get a
checkmark but their TIN did not have strong
quality and cost performance so they got an X.
Although their TIN was able to avoid PQRS
payment adjustments as a group, it was due to
the fact that at least 50% of their eligible professionals met the criteria to avoid PQRS payment adjustment as individuals in 2016. Below
that will be something called the TIN Value
Modifer that I mentioned earlier [Figure 11].
What it does is that it calculates based on quality and cost what your additional adjustment
from the value modifer will be. In this particular example it’s 0% but it can range anywhere
from a -2% if you demonstrated low quality and
high cost up to +2% if in fact you demonstrated
low cost and high quality.
STEP 3, focus on performance. I hope I’ve helped
you understand that the way to improve your
scores is to review the quality benchmarks and
understand what is required for you in your
practice to be able to have above-average performance. Ten implement practice strategies
and clinical workfows to help meet your chosen quality measures for PQRS and the quality
and cost measures that are used under the value
modifer program. With regard to EHR use,
you want to be able to implement workfows to introduce
patients to the patient portal but then also actually encourage them to use it.
LB What about the cost measures? What is included and
how can we impact this component?
RZ Well, you want to establish processes to monitor hos-
pitalizations and measure length of stay. You also may want
to consider medical-home–type services to reduce hospi-
talization. You may also want to look at how your providers
are treating patients and determine whether or not in situ-
ations where there may be multisource drugs available that
are generic, they could possibly be preferred over those that
may be brand name.
In addition, you may also want to look at the practice’s
mechanism for end-of-life and palliative care and come to
some agreement about how you’re going to improve the
FIGURE 8 What does your QRUR show?
FIGURE 9 Your QRUR scatterplot
FIGURE 10 High-risk bonus adjustment
FIGURE 11 The TIN's value modifer