The Centers for Medicare & Medicaid Services (CMS) has made the Quality and Resource Use Reports (QRURs) available to help solo practitioners and group practices better understand their performance in quality and cost metrics. Quality and cost metrics are increasingly being used for accountability purposes under federal value-based purchasing programs.
What is the purpose of QRURs?
QRURs are confidential feedback reports that provide information regarding the cost and the quality of health care that physicians and group practices render to Medicare fee-for-service (FFS) patients. The reports are intended to provide comparative performance data that physicians can use to improve the care provided to Medicare beneficiaries.
CMS also uses some of the information in the QRURs to calculate the physician value-based payment modifier (VM). The VM, implemented in the Affordable Care Act, provides either bonus payments, payment penalties, or a neutral adjustment (no bonus or penalty) to physicians’ Medicare payments based on the quality and cost of the services they provide in comparison with the performance of their peers.
All physicians and group practices will be subject to VM payment in 2017 based on the quality metrics they report in 2015 and the cost of their care. They may be subject to Medicare payment penalties of as much as –4 percent based on quality and cost performance. The quality metrics used to calculate the VM are based on performance in the Physician Quality Reporting System (PQRS). Therefore, it is critical that all surgeons participate in PQRS in 2015 and in the future. Read more information on the VM program. Read more information on the PQRS program.
What is the methodology behind the 2013 QRURs?
The 2013 QRURs include data assessing a group practice or solo practitioner’s performance on cost as well as performance on quality measures. Performance is determined using standardized scoring, which indicates the number of standard deviations from the mean benchmark (expected value) a physician’s or group practice’s performance falls for a given measure. For more information, refer to pages 12–14 of the CMS 2013 QRUR Detailed Methodology document.*
Quality benchmarks are determined by the national mean for each measure’s performance rates in the year prior to the performance year—for example, 2012 data are used to determine the 2013 benchmark. However, cost benchmarks determined by the national mean of performance rates in the current performance year—meaning 2013 QRURs used 2013 data. All cost measures are also payment standardized to adjust for geographic differences, risk-adjusted based on patient characteristics, and adjusted to reflect the specialty mix of professionals in the group. For more information, refer to pages 25–27 of the CMS 2013 QRUR Detailed Methodology document.*
What information does the 2013 report include?
Physicians who were part of group practices of 100 or more eligible health care professionals are subject to the VM starting in 2015 based on their performance in 2013. Therefore, the currently available QRURs provide information on how the group’s quality and cost performance in 2013 could affect their Medicare payments in 2015 under the VM. For physicians using tax identification numbers (TINs) and who participated in the Group Practice Reporting Option program in 2013, the 2013 QRURs also report the PQRS incentive payment earned in that year. For all other physicians, the QRURs provide a preview of how the group or solo practitioner may fare under the VM in the future. The VM will apply to all group practices and solo practitioners in 2017 and will be based on 2015 reporting.
Who has access to the reports?
In October 2014, CMS made QRURs available to physicians and group practices that meet the following criteria:
- Had at least one physician who billed for Medicare-covered services under the TIN in 2013
- Had at least one quality or cost measure included in the QRUR related to at least one Medicare FFS case
The 2013 QRURs were not distributed to groups that did not have at least one physician or for which no quality or cost data could be computed. QRURs also currently are unavailable for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization Model, or the Comprehensive Primary Care Initiative in 2013.
Surgeons should follow the instructions on the CMS’ Quick Reference Guide for Accessing the 2013 QRUR document to obtain their report.†
Are resources available to help me understand my QRUR?
Several resources are available to help surgeons understand their QRURs. On April 9, CMS hosted a webinar for American College of Surgeons (ACS) members regarding the QRURs. During this webinar, CMS walked through each element of the report and answered questions. A recording of the webinar is available online. Additionally, several ACS and CMS resources comprise more information about the report (see sidebar).
*Centers for Medicare & Medicaid Services. Detailed Methodology For the 2013 Quality and Resource Use Reports and 2015 Value-Based Payment Modifier. Available at: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2013-Detailed-Methodology.pdf. Accessed April 29, 2015.
†Centers for Medicare & Medicaid Services. Quick Reference Guide for Accessing the 2013 QRURs. Available at: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/Quick-Reference-Guide-for-Accessing-2013-QRURs.pdf. Accessed May 1, 2015.