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Quality and Resource Use Reports (QRURs)

What is a QRUR?

Quality and Resource Use Reports (QRURs) are confidential feedback reports provided by CMS as part of the Physician Feedback Program/Value-Based Payment Modifier (VM). QRURs provide detailed information about the cost (resources used) and quality of care (based on reported quality measures and other administrative measures) provided by physicians and group practices to certain Medicare patients during a reporting year. The reports are intended to provide comparative performance data that physicians and group practices can use to improve the care provided to Medicare beneficiaries.

Two types of QRURs are available. The first is a mid-year report which provides an informal preview to physicians and group practices on their quality and cost performance to assess strategic adjustments. The second is the annual QRUR which provides official information about quality and cost performance from the previous calendar year and is used to calculate payment adjustments under the VM.

Why is this Important?

CMS is committee to shifting its payment systems toward rewarding quality and lowering costs, which is essential for the health system to improve and be sustainable. The Affordable Care Act authorized CMS to use some of the information in the QRURs to calculate the Physician Value-Based Payment Modifier (VM) and provide either a positive, negative or neutral adjustment to a physician’s Medicare payments based on quality and cost performance, compared to their peers.

In 2017, physicians may be subject to Medicare payment penalties as high as 4% based on quality and cost performance or for failure to satisfy quality reporting requirements under the Physician Quality Reporting System (PQRS) program.

QRURs also give physicians the opportunity to view how CMS evaluated their performance in order to file for an Informal Review during the 60-day response period if they feel they have been incorrectly assessed.

Accessing Your QRUR

QRUR reports can be accessed by logging in at the CMS Physician Value Portion of the CMS Enterprise Portal website.

To login, the provider or a designated user will first need to obtain an Enterprise Identity Management System (EIDM) account from CMS. Information on setting up an account and troubleshooting access is available on CMS’s Medicare Website.

Interpreting a QRUR

Once you have access to your report, the QRUR is broken down into three main sections. The first is a Performance Highlights graph section that includes composite visual representations of your quality and cost scores, and a scatterplot of how you compare to your peers.

The scatterplot also shows what CMS considers average scores, delineated within a yellow cross, as well as positive payment adjustment scores in the High Quality/Low Cost Quadrant, and negative payment adjustment scores in the Low Quality/High Cost Quadrant.

The other two sections are more detailed breakdowns of your performance (or the group’s performance) on quality and cost measures.

CMS provides a number of resources for physicians to help evaluate the QRUR and its impact. These resources can be found below.

QRURs and the Quality Payment Program (QPP)

CMS will continue to use QRURs in the initial year of the QPP, which encompasses the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). In its QPP final rule, CMS explained that 2015 Annual QRURs would be considered the first MIPS performance feedback, recognizing it may not provide sufficient detail for those clinicians who are currently assessed at the tax identification number (TIN) level under the VM, but who may choose to be assessed at the individual level (i.e., their National Provider Identifier (NPI)) under the QPP. CMS stated its intent to provide as much feedback as technically possible to clinicians at the individual level prior to the 2018 performance period.

CMS also expects to provide the 2016 Annual QRUR in early fall 2017, which will show how physicians and group practices performed in 2016 on the quality and cost measures used to calculate the 2018 VM, as well as their 2018 VM payment adjustment. The 2016 Annual QRUR will be the last Annual QRUR provided to physicians and group practices, as the VM program will sunset.

In the next performance feedback, CMS intends to provide information on MIPS data collected in 2017. This may include all applicable data reflecting calendar year (CY) 2017 performance, including data on the MIPS quality and cost performance categories, as well as the MIPS final score and payment adjustment. CMS intends for this performance feedback to be available in its new format by summer 2018.

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