What You Need to Know About Medicare's New “Quality and Resource Use Report”

 


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The QRUR is essentially an annual report card, and its data can affect how you get paid in the future.

Fam Pract Manag. 2015 Nov-Dec;22(6):19-25.

Author disclosure: no relevant financial affiliation disclosed.

Through its Physician Feedback Program, the Centers for Medicare & Medicaid Services (CMS) now creates annual Quality and Resource Use Reports (QRUR) for practices. The report shows how the quality and cost of care you provide to your Medicare patients compare with your peers' performance. You can think of your QRUR as a Medicare “report card,” which can guide practice improvement.

In September 2015, CMS made QRURs available to solo physicians and physician groups that provided services to Medicare patients in 2014 and had at least one eligible case for the quality or cost measures included in the QRUR. Data is reported by Taxpayer Identification Number (TIN); this is how CMS identifies a practice and its patients. CMS considers two or more providers as a group, and the QRUR will provide performance information only at the group level, not at the individual level.

The report is worth paying attention to because it indicates how you will fare under Medicare's Value-Based Payment Modifier (VBPM) program. The VBPM program adjusts a physician's Medicare payment based on quality and cost (or resource use). This shift from volume of care to value will soon be the new reality of how physicians get paid. Under the VBPM, solo physicians or groups whose quality and cost scores are high could be eligible for a bonus to their Medicare reimbursement. On the other hand, solo physicians or groups whose quality and cost scores are low could face penalties that decrease their Medicare reimbursement.

The VBPM penalties are in addition to the payment cuts associated with failing to successfully report to the Physician Quality Reporting System (PQRS) or attest to the Medicare Electronic Health Record (EHR) Incentive Program know as “meaningful use.” The cumulative effect of these penalties could be up to a 9 percent reduction in a practice's Medicare reimbursement, greatly affecting the bottom line.

The QRUR you received this fall contains quality performance data from 2013 and cost performance data from 2014, which will be used to calculate your VBPM for the year 2016 if your practice has 10 or more providers. Solo physicians and groups with fewer than 10 providers will be subject to the VBPM starting in 2017 based on their 2015 performance data, which will be reported in next year's QRUR. In other words, the care you are delivering today can potentially affect your Medicare reimbursement in 2017.

That said, the QRUR can be complex and confusing to understand. Using a de-identified QRUR from a group practice as an example, this article provides a guide to help you better navigate and interpret your report.

How do you access your QRUR?

Obtaining the QRUR can be challenging and frustrating. First, if you have not done so already, you or one person from your group will need to obtain an account from

About the Author

Heidy Robertson-Cooper is senior strategist for health care quality at the American Academy of Family Physicians.

Author disclosure: no relevant financial affiliation disclosed.

 

 

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