Medicare’s Physician Feedback Program gives providers comparative performance information that they can use to improve the care you deliver. Your Quality and Resource Use Reports (QRURs) are a vital component to this program.
What Are QRURs?
QRURs compare practice data to national benchmarks for quality and cost. Through 2016, the quality score, is based on PQRS data submitted by the practice plus three measures CMS-calculates from claims data.
- Acute Conditions Composite
- Chronic Conditions Composite
- All-Cause Hospital Readmissions.
The cost composite measure is based on six individual measures, all calculated by CMS:
- Per Capita Costs for All Attributed Beneficiaries
- Per Capita Costs for Beneficiaries with Diabetes
- Per Capita Costs for Beneficiaries with Coronary Artery Disease (CAD)
- Per Capita Costs for Beneficiaries with Chronic Obstructive Pulmonary Disease (COPD)
- Medicare Spending per Beneficiary
- Per Capita Costs for Beneficiaries with
Medicare adjusts the composite quality and cost scores by peer group based on practice size. Cost measures are also adjusted for risk if the average beneficiary risk is at or above the 75th percentile of beneficiaries nationwide.
The data is based on patients attributed to the practice based on the number of primary care visits either by primary care physicians or specialists. Patients are attributed to the practice at the Tax Identification Number (TIN) level.
The data from the PQRS quality measures comes from patients seen in the practice that are eligible for the measure. However, the CMS-calculated quality and cost measures look at the quality and cost associated with the “attributed patients” and looks at the costs to care for this population of patients, not just for the visits to the providers within the TIN, but for all care provided, including hospitalizations and visits with other providers.
QRURs and the Value Modifier
Based on the scores in the QRUR, under the Value Modifier, and Quality Tiering, a practice can receive a positive, negative or neutral adjustment to their payments related to the Physician Fee Schedule (PFS).
For practices that provide high quality care at a low cost, the potential incentive varies each year. For 2016, the incentive was as much as 30% over and above each and every payment from the PFS.
The Value-Modifer and Quality Tiering Program have been phased in, with practices of 100 or more the first to be subject to a penalty for high cost and low quality. In 2016, the penalty only applied to groups of 10 or more.
The QRURs for services delivered in 2015 have just been released and will affect PFS payments in 2017. For 2017, physicians in groups with two or more PQRS eligible professionals and physician solo practitioners are eligible for both an incentive and penalty.
How often are QRURs available?
There are two types of QRURs released throughout the year. The annual reports include all data and allow you to see how you performed on both provider-submitted measures and CMS-calculated measures. The annual report contains an overall score on cost and quality.
Mid-year reports don’t include PQRS measures; the only measures included are the ones that are calculated by CMS.
What Can Providers Do with Their QRURs?
The data in these reports will be used in the 2018 Value Modifier and are an indication of how you will score under MIPS.
By understanding each cost and quality measure, and understanding the factors that contribute to those measures, practices can begin to look at areas where they can improve.
While this data can help practices evaluate where they are performing poorly, the reports are often outdated by the time they become available. For example, reports for the period of July 1, 2014 through June 30, 2015 were not available until June of 2016.
However, unless your practice has made changes that would influence these measures, the historical data is the best indicator of how you will perform in the future.
Mingle Health can evaluate your reports and help you determine areas where you may be able to improve.
How Can Providers Access Their QRURs?
All that is required to access the reports is an EIDM account through CMS. If you don’t have an account already, Mingle Health can assist you in getting one. To learn when they become available, you can subscribe to get updates from CMS. The team at Mingle Health also informs clients when reports become available.
How Will QRURs Work Under the Quality Payment Program?
CMS has promised to make QRURs more readily available under the new Quality Payment Program, while also making feedback on the reports more actionable. In the future, there will also be new cost measures that reflect episodes of care. You can use the results of the CMS-calculated measures to estimate your Final Score for Quality and Resource Use.
Understanding your QRURs gives insight into how you will fare under Quality Tiering for the 2018 incentive or penalty and help you estimate your quality score for MIPS in 2017. Resource Use under MIPS will not be a factor in 2017 but it is scheduled to be 30% of your final score for 2019. Making changes now will be very important to succeed in 2019.
The data in your QRURs is complex. You can contact our team of friendly consultants and we’ll help you interpret your scores and guide you toward successful submissions for PQRS and help you maximize your score under MIPS.
Dr. Dan Mingle shares key changes to MIPS from the 2019 Final Rule.