Understanding AQRUR

• The New England Quality Innovation Network-

Quality Improvement Organization (QIN-QIO) is administered by Healthcentric Advisors in partnership with Qualidigm. Together, they serve as the QIN-QIO for all six New England states.

• CSMS is assisting the New England QIN-QIO in

developing and disseminating information about Medicare quality programs.

In Context

What is AQRUR? CMS Annual Quality and Resource Use Report

The QRUR is a component of the Value Based Payment Modifier program (VM) – it provides data on quality of care and the resources used to provide that care to Medicare FFS beneficiaries

An AQRUR is provided for each TIN; data includes: • Quality and cost measures • VM calculation for groups of 10+ EPs* • Quality tier designation (high, average, low), and • Benchmark data for peer comparisons

*For groups of 1 – 9 EPs, the 2014 AQRUR is informational only

Who is an Eligible Professional (EP)? CMS recognizes 3 types of EP:

Medicare Physicians Practitioners Therapists Doctor of Medicine Doctor of Osteopathy Doctor of Podiatric Medicine Doctor of Optometry Doctor of Oral Surgery Doctor of Dental Medicine Doctor of Chiropractic

Physician Assistant Nurse Practitioner* Clinical Nurse Specialist* Certified Registered Nurse Anesthetist* (and Anesthesiologist Assistant) Certified Nurse Midwife* Clinical Social Worker Clinical Psychologist Registered Dietician Nutrition Professional Audiologists *Includes Advanced Practice Registered Nurse (APRN)

Physical Therapist Occupational Therapist Qualified Speech-Language Therapist

Attribution Methodology Step 1: A beneficiary receives the plurality of primary care

services from primary care physicians* in your TIN

Step 2: Beneficiaries who did not receive a primary care service from a primary care physician are attributed to your TIN if: – They received at least one primary care service** from a physician of any

specialty within the TIN, and – They received a plurality of the primary care services from specialist

physicians, nurse practitioners, physician assistants, and clinical nurse specialists within the TIN.

*Family Practice, Internal Medicine, General Practice, and Geriatric Medicine specialty codes **E&M office visits, other outpatient services, skilled nursing facility services, and those

services rendered in home settings

AQRUR Data Costs are identified through allowed Medicare Part A and Part B charges. These figures have been:

•Payment standardized to remove geographic payment differentials

•Risk adjusted to account for differences in beneficiary medical history

•Specialty adjusted to account for differences in TIN specialty mix

AQRUR Data Cost Measures – Per Capita Quality Measures

General (2) • All attributed beneficiaries •Medicare Spending per Beneficiary (MSPB)

•30-Day All Cause Hospital Readmission • Acute Ambulatory Care-Sensitive Condition (ACSC) Composite • Chronic ACSC Composite

Condition-Specific (4) •Beneficiaries with Diabetes • Beneficiaries with COPD • Beneficiaries with CAD • Beneficiaries with Heart Failure

2015: What You Need to Know There is a 2-year lag between reporting and payment

adjustment

• The 2014 AQRURs are now available, and contain data from 1/1/14 – 12/30/14

• The 2014 AQRUR will be used to calculate the 2016 Value Modifier (VM) that will be applied to payment adjustments in 2016 for groups of 10+ EPs

• For solo & small groups (2-9), the 2014 AQRUR is informational only – no effect on 2016 payments

• 2015 QRUR data will be used to calculate the VM that will be applied to payment adjustments in 2017 for all EPs

Obtaining AQRUR An Enterprise Identity Data Management (EIDM) account is needed to access

your AQRUR For a solo EP (TIN with only 1 NPI billing under TIN) EIDM roles include:

• Individual Practitioner • Practitioner Representative

For a group of 2+ EPs (TIN with 2+ NPIs billing under the TIN) EIDM roles

include:

• Security Official • Group Representative

Log into the CMS Secure Portal at https://portal.cms.gov/

https://portal.cms.gov/

Decoding AQRUR

AQRUR Components

• Performance Highlights • 12 Exhibits • 13 Supplementary Exhibits

PresenterPresentation NotesThe report also provides a summary of the report methodology and links to supplementary exhibits (more on those later).

AQRUR Performance Highlights Quality Composite Score

Cost Composite Score

Quality Tiering Performance

AQRUR Performance Highlights

PresenterPresentation NotesThe report also provides a summary of the report methodology and links to supplementary exhibits (more on those later).

AQRUR Exhibits The AQRUR provides 12 data sets (“Exhibits”)

Exhibit 1: Eligible Professionals in Your TIN

Exhibit 2: Beneficiaries Attributed to Your TIN

Exhibit 3: Primary Care Services Provided to Attributed Beneficiaries

Exhibit 4: Hospital Episodes/Spending per Beneficiary Measure

Exhibit 5: Your 2014 TIN Performance by Quality Domain

Exhibit 6: Your TIN Performance on Quality Measures by Domain

AQRUR Exhibits The AQRUR provides 12 data sets (“Exhibits”)

Exhibit 7: Hospitals Admitting Attributed Beneficiaries Exhibit 8: Hospitals Accounting for Episodes of Care for

Attributed Beneficiaries Exhibit 9: 2014 TIN Performance by Cost Domain Exhibit 10: Per Capita/Per Episode Costs for Attributed

Beneficiaries Exhibit 11: Per Capita Cost Differentials Exhibit 12: Hospital Episodes/Spending per Beneficiary

Measure

Exhibit 1: Eligible Professionals

• This is the list of physicians and non-physician EPs billing under your TIN

Exhibit 2 & 3: Attributed Beneficiaries

1st step of attriution

Exhibit 4: Medicare Spending per Beneficiary

(MSPB) Hospitalization Episodes

A hospitalization episode is attributed your TIN if you provided more Part B services than any other TIN. A lower number of unique beneficiaries relative to the total episodes of hospital care could indicate that some beneficiaries had multiple hospitalizations. Consider enhanced care management support for these patients.

PresenterPresentation Notes

Exhibit 5: Performance by Quality Domain

Exhibit 5 is only populated for TINs that met the criteria to avoid the 2016 PQRS payment adjustment and:

1.) Reported quality data via the PQRS GPRO or 2.) At least 50% of the EPs in the TIN reported PQRS quality data as individuals

Quality Composite Score

Exhibit 6: Quality Measures by Domain

Exhibit 7: Hospitals Admitting TIN-Attributed Beneficiaries

Exhibit 8: Hospitals Accounting for Episode of Care for MSPB Measure

Exhibit 9: TIN Performance by Cost Domain

Cost Composite Score

Exhibit 10: Per Capita/Per Episode Costs

Exhibit 11: Per Capita Cost Differentials

Exhibit 12: Per Episode Cost Differentials

Supplementary Exhibits

These exhibits build on the AQRUR information to provide a better understanding of your TIN’s beneficiaries, their use of health services, and other TINs involved in their care.

These are provided as downloadable Microsoft

Excel files, so you can custom sort and review data. They also contain definitions, notes, and discharge status codes.

Supplementary Exhibits Supplementary Exhibits Overview

Supplementary Exhibit 1 For each EP billing under your TIN, you can find

• NPI number and name • Physician/Non-physician • Specialty Designation • Identified through PECOS and/or Medicare billing • Date of last claim billed under TIN

Look for: incorrect listings of EP or specialty. Make sure PECOS records are updated, and contact your TIN’s Medicare Administrative Contractor (MAC) to see whether claims can be corrected.

Supplementary Exhibit 2A: Beneficiaries Attributed to Your TIN

Cost Measures, Claims-Based Outcome Measures & Care

• Verify beneficiaries attributed to your TIN • Identify beneficiaries with 1 of 4 chronic conditions • Identify beneficiaries who received services outside your TIN • Review EPs billing for the most services for the beneficiary

• In your TIN • Outside your TIN

• Verify claims information • Date of last hospital admission

Look for: high-risk beneficiaries, and low-risk beneficiaries with

high % of costs. Improved care coordination and patient self-management education can be helpful for both groups

PresenterPresentation NotesThis data can help you find ways to improve and maintain quality and efficiency in care delivery

Supplementary Exhibit 2B: Beneficiaries attributed to your TIN/Cost Measures

• Costs of care provided to beneficiaries in 2A • Total payment-standardized FFS Medicare costs and

distribution of costs across service categories • Identify your TIN’s cost drivers Look for: unexpected service patterns, cost drivers,

high rates of emergency care or post-acute care. These represent opportunities to improve care coordination and monitoring.

Supplementary Exhibit 3 Hospital admissions for any cause

• Beneficiary • Admitting hospital • Principal diagnosis associated with admission • Admission from ED evaluation, ACSC, or 30-day

readmission • Date of admission/discharge • Subsequent care environment Look for: opportunities to align/coordinate care,

improve information sharing, and increase beneficiary engagement in care. These can reduce preventable hospital admissions.

PresenterPresentation NotesAlthough this says “any cause,” it does not include hospitalizations with a primary diagnosis of alcohol or substance abuse

Supplementary Exhibit 4 Medicare Spending Per Beneficiary (MSPB) • Beneficiary characteristics • Apparent lead EP • Episode hospitalization features • Episode cost by category of service • Total payment-standardized episode cost Look for: high category of service costs, principal

diagnoses of high-cost episodes, relative costs of hospitals/post-acute care options in your area.

PresenterPresentation NotesA beneficiary who had more than one episode eligible for the MSPB measure will be included in the exhibit for each episode.

Supplementary Exhibit 5: Per Capita Costs by Categories of Service

• Number and % of beneficiaries using a service category • Payment-adjusted, risk-standardized per capita costs • Differential in your TIN’s per capita costs, and those of

peer TINs • Provides details for services behind data in Exhibit 11

Look for: patterns of utilization involving other TINs, and

consider ways to increase care coordination. Review clinical guidelines for high-percentage procedures.

PresenterPresentation NotesCosts reflect care furnished by all providers, not only those in your TIN

Supplementary Exhibit 6: Per Episode Costs by Categories of Service (MSPB)

• % of beneficiaries using a service category • Payment-adjusted, specialty-adjusted, risk-standardized

per episode costs • Differential in your TIN’s per episode costs, and those of

peer TINs • Provides details for services behind data in Exhibit 12

Look for: patterns of utilization involving other TINs, and

consider ways to increase care coordination. Review clinical guidelines for high-percentage procedures.

PresenterPresentation NotesCosts reflect care furnished by all providers, not only those in your TIN

Supplementary Exhibits 7-10: Per Capita Costs/Specific Conditions

Data for attributed beneficiaries with: Diabetes (Exhibit 7), Chronic Obstructive Pulmonary Disease (Exhibit 8), Coronary Artery Disease (Exhibit 9), and Heart Failure (Exhibit 10)

• % of beneficiaries using a service category • Payment-adjusted, specialty-adjusted, risk-standardized per

episode costs • Differential in your TIN’s per episode costs, and those of peer

TINs • Provides details for services behind data in Exhibit 12

PresenterPresentation NotesCosts reflect care furnished by all providers, not only those in your TIN

Supplementary Exhibit 11: Individual EP Performance on PQRS Measures

PQRS performance data for each EP in your TIN who participated in PQRS in 2014 • Identify measure information and VM domains • Verify PQRS reporting mechanism • Identify # of eligible cases in performance

denominator • Compare your TIN’s performance with peer TINs • Identify whether the EP met the criteria to avoid the

2016 payment adjustment

PresenterPresentation NotesCosts reflect care furnished by all providers, not only those in your TIN

Supplementary Exhibit 12: Summary of 2014 GPRO Earned Incentive

For TINs eligible for the 2014 GPRO earned incentive:

• Total earned incentive amount for your TIN • Incentive as % of total Part B allowed PFS charges

PresenterPresentation NotesCosts reflect care furnished by all providers, not only those in your TIN

Supplementary Exhibit 13: Hospital Admissions for Any Cause/

ACO Assigned Patient Population

For TINs participating in the Shared Savings Program • Beneficiary • Admitting hospital • Principal diagnosis associated with admission • 30-day readmission? • Date of admission/discharge • Subsequent care environment

PresenterPresentation NotesCosts reflect care furnished by all providers, not only those in your TIN

The Big Picture

2016 VM Adjustment Factor*

• Max +2.0x for 10-99 EPs • Max +2.0x for 100+ EPs Upward

• No adjustment Neutral

• 10-99 EPs held harmless • Max -2.0x for 100+EPs Downward

*VM is not applied to solo EPs or groups of 2-9 in 2016

2017 VM Adjustment Factor

• Max +2.0x for solo, 2-9 EPs* • Max +4.0x for 10+ EPs* Upward

• No adjustment Neutral

• Solo, 2-9 EPs held harmless • Max -4.0x for 10+ EPs Downward

*If the average beneficiary risk score is in the top 25%, EPs can receive an additional +1.0x adjustment

Medicare Payment Adjustment: The Big Picture

For solo EPs or groups of 2-9 EPs who successfully participate in PQRS and MU in 2015:

*Solo EPs & groups of 2-9 EPs will be held harmless from downward VM adjustments if they successfully participate in PQRS

**Amount depends on date of first demonstration of MU

PQRS

no downward payment

adjustment in 2017

VM * +2.0x or +1.0x or Neutral

in 2017

MU ** $4,000- $12,000

in 2017

Medicare Payment Adjustment: The Big Picture

For groups of 10+ EPs who successfully participate in PQRS and MU in 2015:

PQRS

no downward payment

adjustment in 2017

VM +4.0x or +2.0x or Neutral

in 2017

MU $4,000-

$12,000* in 2017

* Amount depends on date of first demonstration of MU

Summing It Up: AQRUR Data

• Provides an opportunity to identify areas for 2015 cost/quality improvement for Medicare beneficiaries attributed to your TIN

• Used to determine the Value Modifier (VM) applied to Medicare FFS payments

QRUR Resources

AQRUR http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/PhysicianFeedbackProgram/Downloads/2014-Understanding-Your-QRUR.pdf

Questions and Answers about the 2014 MYQRUR http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/PhysicianFeedbackProgram/Downloads/2014-FAQs-QRUR.pdf

Annual QRUR Data Dictionary https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/PhysicianFeedbackProgram/Downloads/2014-AQRUR-Data-Dictionary.zip

CSMS provides regular updates on QRUR, PQRS, and other Medicare quality programs Visit csms.org/Medicare to learn more

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-Understanding-Your-QRUR.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-Understanding-Your-QRUR.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-Understanding-Your-QRUR.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-FAQs-QRUR.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-FAQs-QRUR.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-FAQs-QRUR.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-AQRUR-Data-Dictionary.ziphttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-AQRUR-Data-Dictionary.ziphttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-AQRUR-Data-Dictionary.zip

Additional QRUR Resources Obtaining an EIDM Account http://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/PhysicianFeedbackProgram/Downloads/Guide-for-Obtaining-a-New-User-EIDM-Account-with-a-Physician-Quality-and-Value-Programs-Role.pdf

Decoding AQRUR Sample AQRUR https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/PhysicianFeedbackProgram/Downloads/2014-Sample-Annual-QRUR.pdf

Sample Supplementary Exhibits www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.zip

2014 QRUR/2016 VM Methodology https://www.cms.gov/Medicare/Medicare-Fee-for-

Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdf

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Guide-for-Obtaining-a-New-User-EIDM-Account-with-a-Physician-Quality-and-Value-Programs-Role.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Guide-for-Obtaining-a-New-User-EIDM-Account-with-a-Physician-Quality-and-Value-Programs-Role.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Guide-for-Obtaining-a-New-User-EIDM-Account-with-a-Physician-Quality-and-Value-Programs-Role.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-Sample-Annual-QRUR.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-Sample-Annual-QRUR.pdfhttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttp://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Sample-2014-MYQRUR-Supplementary-exhibits-.ziphttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdfhttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014QRUR-2016VM-DetailedMethodology.pdf

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Slide Number 1Slide Number 2Slide Number 3What is AQRUR?Who is an Eligible Professional (EP)?Attribution MethodologyAQRUR DataAQRUR Data2015: What You Need to Know Obtaining AQRURSlide Number 11AQRUR ComponentsAQRUR Performance HighlightsAQRUR Performance Highlights AQRUR Exhibits AQRUR Exhibits Exhibit 1: Eligible ProfessionalsExhibit 2 & 3: Attributed BeneficiariesExhibit 4: �Medicare Spending per Beneficiary�(MSPB) Hospitalization EpisodesExhibit 5: �Performance by Quality Domain Exhibit 6: �Quality Measures by DomainExhibit 7: Hospitals Admitting �TIN-Attributed BeneficiariesExhibit 8: Hospitals Accounting for Episode of Care for MSPB MeasureExhibit 9: �TIN Performance by Cost DomainExhibit 10: �Per Capita/Per Episode Costs Exhibit 11: Per Capita Cost Differentials Exhibit 12: Per Episode Cost DifferentialsSupplementary Exhibits Supplementary Exhibits Supplementary Exhibit 1Supplementary Exhibit 2A: Beneficiaries Attributed to Your TINSupplementary Exhibit 2B: Beneficiaries attributed to your TIN/Cost MeasuresSupplementary Exhibit 3Supplementary Exhibit 4Supplementary Exhibit 5: Per Capita Costs by Categories of ServiceSupplementary Exhibit 6: Per Episode Costs by Categories of Service (MSPB)Supplementary Exhibits 7-10: �Per Capita Costs/Specific Conditions Supplementary Exhibit 11: Individual EP Performance on PQRS MeasuresSupplementary Exhibit 12: �Summary of 2014 GPRO Earned Incentive Supplementary Exhibit 13:�Hospital Admissions for Any Cause/�ACO Assigned Patient Population2016 VM Adjustment Factor* 2017 VM Adjustment Factor Medicare Payment Adjustment: �The Big PictureMedicare Payment Adjustment: �The Big PictureSumming It Up: �AQRUR DataQRUR ResourcesAdditional QRUR ResourcesSlide Number 49Slide Number 50