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

Quality and Resource Use Reports

Starting in 2017, the Merit-based Incentive Payment (MIPS) System merges the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VM), and the EHR Incentive Program (EHR-MU); adds a new component called Improvement Activities; and combines these components into a single composite MIPS Final Score. As part of MIPS, providers will continue to have the option to review QRURs to understand their performance in the MIPS compared to other MIPS providers. For 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 early October 2015, CMS made the QRURs available, which reflect performance on quality and cost measure data collected in 2015. 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 2017.

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 2017 based on a composite score of metrics they reported under the PQRS in 2015, and multiple other quality and cost metrics that CMS automatically calculates based on claims. In 2017, eligible professionals may be subject to Medicare payment penalties as high as 4% based on quality and cost performance or for failure to satisfy PQRS reporting requirements. Because satisfactory PQRS reporting is a critical component of the VM, it is critical that all surgeons participate in the PQRS in 2016 and beyond.

Methodology

The 2015 QRURs provide performance and payment adjustment information for all providers that were held accountable under the VM in 2017. For 2017, VM payment adjustments will apply to all providers. Physician groups with between two to nine eligible professionals (EPs) and physician solo practitioners are subject to upward, neutral or downward Medicare payment adjustments of up to -2% based on 2015 performance, while physician groups with 10 or more EPs are subject to upward, neutral or downward Medicare payment adjustments of up to -4%.

The 2015 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., 2014 data). Cost benchmarks are based on the national mean of performance rates during the current performance year (i.e., 2015 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.

2015 Mid-Year QRUR Available

The 2015 Mid-Year QRUR provides a preview of a physician's solo or group practice performance on nine measures that CMS calculates from Medicare fee-for-service claims data. These measures are a subset of the measures that will be used to calculate the 2017 VM. The 2015 Annual QRUR, based on data from January 1, 2015 to December 31, 2015, will be available in fall of 2016 and will show the solo provider or group practices actual performance on all quality and cost measures that will be used to calculate the 2017 VM.

The following information is not included in the 2015 Mid-Year QRUR:

  1. Quality composite and cost composite scores for the 2017 VM
  2. Group or individually reported Physician Quality Reporting System PQRS data (including Consumer Assessment of Healthcare Providers and Systems [CAHPS])
  3. Information about the 2017 VM payment adjustment

For information on how to access your 2015 Mid-Year QRUR see the Quick Reference Guide for Accessing the 2015 Mid-Year QRURs and Tables on the CMS website.

How to Access Your 2015 QRUR

In October 2016, CMS made available QRURs based on care provided in 2015 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 2015 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 2015.

Authorized representatives of group and solo practitioners can access the 2015 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 2015 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 from September 26, 2016 through November 30, 2016.

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 Molly Peltzman at mpeltzman@facs.org.