American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Quality and Resource Use Reports

Starting in 2017, Centers for Medicare & Medicaid Services (CMS) merged its previous physician quality programs into the Merit-based Incentive Payment System (MIPS). MIPS includes four components: Quality, formerly known as the Physician Quality Reporting System (PQRS); Advancing Care Information (ACI), formerly known as Electronic Health Record Incentive Payment Program, or Meaningful Use; Cost, formerly known as the Physician Value-Based Payment Modifier (VM) program; and Improvement Activities, a new category. These four components combine to form a MIPS Final Score which determines a MIPS eligible clinician’s Medicare Part B incentive payment for the payment year. For 2017, Quality accounts for 60 percent of the MIPS final composite score, and ACI and IA account for 25 and 15 percent, respectively. Due to ongoing development, the Cost component has a weight of zero. For more information on the MIPS program, please visit the ACS Quality Payment Program Resource Center.

2015 marked the first year that the Center for Medicare & Medicaid Services (CMS) distributed Quality and Resource Use Reports (QRURs) to all solo practitioners and group practices nationwide. In September, CMS made the 2016 QRURs available, which reflect performance on quality and cost measure data collected in 2016. These reports serve as a tool to help solo practitioners and group practices better understand their performance on federal quality and cost metrics, which already impact Medicare payments for select physicians and will impact payments for all physicians starting in 2018.

Purpose

QRURs are confidential feedback reports offered under CMS’ Physician Feedback Program that provide information about the resources used (cost) and the quality of care provided by physicians and group practices 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.

Some of the information in the QRURs is also used by CMS to calculate the Physician VM. The VM, authorized under the Affordable Care Act, provides either bonus payments, payment penalties, or a neutral adjustment (no bonus or penalty) to a physician’s Medicare payments based on quality and cost performance, compared to their peers.

Note that all physicians and group practices will be subject to the VM in 2018 based on a composite score of metrics they reported under the PQRS in 2016, and multiple other quality and cost metrics that CMS automatically calculates based on claims. In 2018, eligible professionals may be subject to Medicare payment penalties as high as 2 percent based on quality and cost performance or for failure to satisfy PQRS reporting requirements.

Methodology

The 2016 QRURs provide performance and payment adjustment information for all providers that were held accountable under the VM in 2018. For 2018, VM payment adjustments will apply to all providers. 

The 2016 QRURs include data assessing a group practice or solo practitioner’s performance on cost metrics (including analyzing the services and procedures contributing most to a beneficiaries’ cost), as well as performance on quality measures (including, PQRS measures reported by the group practice or individual). Performance is determined using standardized scoring, which shows how many standard deviations from the mean benchmark a physician or group practice’s performance on a given measure falls.

Quality benchmarks are based on the national mean of each measure’s performance rate during the year prior to the performance year (i.e., 2015 data). Cost benchmarks are based on the national mean of performance rates during the current performance year (i.e., 2016 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.

How to Access Your 2016 QRUR

In September 2017, CMS made available QRURs based on care provided in 2017 to physicians and groups that

  • Had at least one physician who billed for Medicare-covered services under the Tax Identification Number (TIN) in 2015; and
  • Had at least one quality or cost measure attributed to the group or solo practitioner related to at least one Medicare FFS case.

Note that the 2016 QRURs were not distributed to those groups who did not have at least one physician or for whom no quality or cost data could be computed. QRURs also are currently available 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 2016.

Authorized representatives of group and solo practitioners can access the 2016 Annual QRURs via the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. Note that the EIDM recently replaced IACS IDs. The log in for EIDM will be the same for those who already have an IACS account. However, new users will need to establish a new EIDM account. For more information on how to access the 2016 Annual QRURs, visit How to Obtain a QRUR.

Informal Review

For physician solo practitioners and physician groups with two or more eligible professionals that are subject to the 2017 Value Modifier, CMS established a 60-day Informal Review Period that began after the release of the 2015 Annual QRURs, to request a correction of a perceived error in their 2017 Value Modifier calculation. The informal review period for the 2017 Value Modifier is open until 8:00 pm (EST) December 1, 2017. For more information about the informal review process, view the guide “2016 PQRS: 2018 Downward Payment Adjustment = Informal Review Made Simple” on the PQRS Analysis and Payment webpage.

Additional Resources

CMS QRUR Page

CMS Help Desk

  • For issues with obtaining EIDM account and accessing QRURs, call 888-288-8912.
  • For assistance with interpreting QRURs and requesting an informal review of your data, contact the QRUR Help Desk at 888-734-6433 (select option 3) or pvhelpdesk@cms.hhs.gov.

CMS Guide for Obtaining a New EIDM Account

Sample 2015 QRUR

CMS Document on Detailed Attribution Methodology for Total Per Capita Cost Measures

Information on PTAN

Value-Based Payment Modifier

For further information, please contact Bobby Kopp at rkopp@facs.org or 202-672-1506.