Medicare Quality and Resource Use Reports (QRURs)
The Centers for Medicare & Medicaid Services (CMS) has compiled individual quality and resource use reports (QRURs) for physicians in nine states as well as group-level reports for large groups of physicians that participated in the PQRS group practice reporting option (GPRO) in 2011. The intent of the QRURs is to provide confidential information to physicians and other medical professionals about the resources used to treat their Medicare fee-for-service (FFS) patients, per capita costs per beneficiary, and performance on quality measures derived from CMS-calculated administrative claims and the PQRS. The report quantifies and compares patterns of resource use and cost among similar physicians.
In December 2012, CMS provided group-level confidential feedback report to 54 large group practices. Available Dec. 17, 2012-April 2013 are feedback reports for about 94,000 individual physicians practicing in groups of twenty-five or more eligible professionals (EPs) who provided care in one of nine states: California, Illinois, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, and Wisconsin during calendar year 2011. For information about how physicians can obtain their own QRUR go to www.qrurinfo.com -personal identifiers are required.
The Affordable Care Act requires CMS to develop a Medicare episode grouper by January 1, 2012, and to include episode-based costs in the Quality and Resource Use Reports (QRURs). CMS has developed a prototype episode grouper for cardiac and pneumonia-related conditions. To illustrate how the prototype CMS Episode Grouper works, CMS developed and distributed “supplemental” QRURs to the 54 large group practices in June, 2013 that previously were provided group QRURs in December 2012.
The idea behind these reports is to provide meaningful and actionable information so physicians can improve the care they furnish, and move toward physician reimbursement that rewards value rather than volume. The QRURs previews some of the quality and cost data that will be used by CMS to calculate the Value-Based Payment Modifier (VBPM). Section 3007 of the Affordable Care Act mandates that, by 2015, CMS begin applying a VBPM under the Medicare Physician Fee Schedule. For calendar year 2015, Medicare will apply a VBPM to groups of physicians (identified by a single Taxpayer Identification Number, or TIN) with 100 or more EPs, based on their performance during calendar year 2013. Practice administrators should review the QRURs with their physicians in advance, before the VBPM is implemented in 2015, to identify areas that may positively or negatively affect your reimbursement. Note by 2017, the VBPM will be applied to all physicians who bill Medicare for services provided under the physician fee schedule.
Contact CMS to comment and ask questions about the QRURs by leaving a voicemail at 855.272.3635 or sending an email. Please note you will need the physician’s national provider identifier (NPI) number when leaving a voicemail. Additionally, you will want to include the NPI number in any e-mail correspondence.
Members with concerns regarding the content and/or accuracy of the QRURs that you would like to share with MGMA Government Affairs to assist our ongoing advocacy efforts, please contact Jennifer McLaughlin, Government Affairs Representative at email@example.com.