MACRA Resrouce Performance Category – Relationship to Physician Value-Modifier

Value Modifier utilizes 6 cost measures:

  1. Total Per capita costs for all attributed beneficiaries  (TOTAL PER CAPITA MEASURE)
  2. Total per capita costs for all attributed beneficiaries with (Chronic Obstructive Pulmonary Disease) COPD
  3. Total per capita costs for all attributed beneficiaries with (Congestive Heart Failure) CHF
  4. Total per capita costs for all attributed beneficiaries with (Coronary Artery Disease) CAD
  5. Total per capita costs for all attributed beneficiaries with Diabetes Mellitus (DM)
  6. Medicare Spending per Beneficiary (MSPB)

Total per capital costs include payments under both Part A and Part B, but do not include Part D, drug expenses.

Understanding the attribution of the Per capita costs: All cost measures for the VM are attributed at the physician group and solo practice level using the Medicare-enrolled billing TIN under a two-step attribution methodology. They are risk adjusted and payment standardized and the expected cost is adjusted for the TINS specialty composition. ()

Attribution of the MSPB: The MSPB is attributed to the TIN that provides the plurality of Medicare Part B claims (as measured by allowable charges) during the index inpatient hospitalization.

QRUR Reports: The total per capital cost measures include payments for a calendar year and have been reported to  TINs for several years through the Quality and Resource Use Reports (QRURs) which are issued as part of the physician feedback program. Usually QRUR reports for previous year are released in September of each year.

 

 

 

 

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