Quality and Resource Use Reports (QRURs)

Making Sense of the QRUR

AAFP members can view this four-part on-demand series, which provides guidance in using QRUR data to evaluate and improve the care you provide to your patients.

What is a QRUR and Why Should I Care?

The Quality and  Resource Use Report (QRUR) shows how your payments under Medicare Part B fee-for-service (FFS) will be adjusted based on quality and cost. Through its Physician Feedback Program, the Centers for Medicare & Medicaid Services (CMS) produce QRURs for all solo physicians and physician groups that have billed Medicare Part B FFS during the reporting year. The QRUR includes information regarding performance on quality and cost of care measures delivered to patients. It is a part of CMS’s effort to move physician payment toward a system that rewards value over volume.

The QRUR analyzes performance at the Tax Identification Number (TIN) level. The report includes performance information from measures reported through the Physician Quality Reporting System (PQRS) and uses Medicare claims to calculate additional quality outcome measures and cost measures. Performance is compared to benchmarks of similar peer groups. Data in the QRUR is used to calculate your Value Based Payment Modifier (VBPM) and subsequent payment adjustments (positive, negative, or neutral).

CMS provides QRURs as a means to help physicians and groups understand the care they deliver to Medicare beneficiaries and identify opportunities for improvement in that care. Reviewing your practice’s QRUR gives you information that can help your practice maximize payments now and in the future. 

Frequency and Types of QRURs

The QRUR feedback report is produced twice a year.

Mid-year QRUR

The mid-year QRUR is for informational purposes only and does not affect your Medicare FFS payments. It’s a checkpoint to let you assess your performance and adjust it accordingly. The mid-year QRUR only contains data on CMS-calculated quality and cost measures.

Annual QRUR

The annual QRUR provides comprehensive information from the reporting period (January – December), and includes quality measures reported to PQRS, along with CMS-calculated quality and cost measures. The information is used to determine adjustments to your Medicare FFS payments under the VBPM. Annual QRURs become available in the fall following the reporting period. The 2015 annual QRUR will provide information about performance from calendar year 2015. It will be available fall 2016, and will determine 2017 Medicare Part B FFS payment adjustments.

How Can I Use the QRUR?

You can use the QRUR to better understand the quality of care you delivered during the performance period and compare it to your peers. You can use it to your advantage by streamlining resource use and identifying care coordination opportunities for patients. Relatively high performers might use this information to market their practice, negotiate contracts with payers, and earn incentive payments. Practices may also target specific areas of weaker performance and implement evidence-based strategies to improve.

Reviewing your QRUR and identifying opportunities to improve the quality and cost of care you provide will help your practice prepare for the upcoming Medicare Access and CHIP Reauthorization Act (MACRA) legislation. MACRA will use certain aspects of the PQRS and VBPM programs when the first performance period begins in 2017. Your QRUR can help you assess your practice’s performance to help optimize payments now and when MACRA begins.

How Can I Access my QRUR?

QRURs are available at the TIN level and accessed via the CMS Enterprise Portal(portal.cms.gov) by authorized individuals of solo or group practices. Each TIN needs a designated “security official,” or in the case of solo practices, an “individual practitioner.” This role is acquired through the CMS Enterprise Identity Management (EIDM) system. Physicians from small practices and solo providers can access their QRURs directly by acquiring the appropriate role. Employed physicians from larger practices and health systems would normally request a QRUR copy from administrative or quality department staff.

The process to access a QRUR can be difficult to navigate. CMS offers a quick reference guide(www.cms.gov) with screenshots that walks you through the process. You may contact the QualityNet Help Desk at qnetsupport@hcqis.org or (866) 288-8912 for assistance with EIDM accounts, QRURs, PQRS, and measure-specific questions.

Additional QRUR Resources

AAFP Resources:

Tips for Using the QRUR Tables as Excel Spreadsheets(4 page PDF) – Step-by-step guidance on downloading your QRUR tables so you can sort and filter the data

Practice Management – Includes AAFP resources on practice transformation, quality improvement, and physician payment

Risk-Stratified Care Management and Coordination(1 page PDF) – Comprehensive rubric that helps you identify your patients’ risk categories to implement risk-stratified care management (free to AAFP members)

MACRA Ready – News, key dates, an on-demand video series, and other AAFP resources to help you prepare for MACRA and value-based payment

Making Sense of MACRA: Using Data to Prepare(6 page PDF) – Tips on using your QRUR to discover practice improvements that maximize payments, both now and when MACRA begins

Coding and Medicare Care Coordination – Information about ICD-10 and the CPT codes for chronic care management, transitional care management, and advance care planning

Robertson-Cooper H. What you need to know about Medicare's new “Quality and Resource Use Report.” Fam Pract Manag. 2015;22(6):19-25.

CMS Resources: