QRUR 101: Understand, Utilize Quality and Resource Use Reports

November 25, 2015 09:48 am Sheri Porter

News flash: CMS recently announced that it was issuing revised QRURs due to a technical glitch that affected initial reports issued in September.

Say what?

[Two people reviewing reports on electronic notebook]

If you are a family physician who knows that "QRUR" stands for Quality and Resource Use Report, here's a thumbs up. And major kudos to FPs who recognize that the reports are extremely important in terms of future Medicare payments.

All levity aside, family physicians knee deep in patient care and running their practices have little time left to keep up with the fine print surrounding a payment system that is rapidly shifting from traditional fee-for-service payment based on volume to one focused on quality and value.

In an effort to bring family physicians up to speed with the particulars of QRURs, Family Practice Management (FPM) recently published an article titled "What You Need to Know About Medicare's New 'Quality and Resource Use Report.'"

Story Highlights
  • Physicians should learn how to utilize CMS' Quality and Resource Use Reports (QRURs) because they highlight information that will soon impact Medicare payment.
  • The reports indicate how physician practices will fare under the Value-based Payment Modifier Program.
  • Family Practice Management recently published an article to help physicians understand how to access their QRURs and how to read the reports once they have them in hand.

Author Heidy Robertson-Cooper, M.P.A., an AAFP senior strategist for health care quality wrote this about practices' individualized reports: "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," said Robertson-Cooper.

She noted that VBPM penalties would accrue in addition to pay cuts some physicians would face for failing to successfully report to the Physician Quality Reporting System (PQRS) or attest to meaningful use of their electronic health record system.

"The cumulative effect of these penalties could be up to a 9 percent reduction in a practice's Medicare reimbursement," said Robertson-Cooper. "Real money is on the line."

She encouraged physicians to embrace QRURs as a resource to ease the transition to a refocused payment system. "Use the QRUR to your advantage to target improvement strategies, avoid penalties and potentially receive a bonus," Robertson-Cooper advised.

Drilling Down

As detailed in the FPM article, QRURs were devised as a report card, of sorts -- a way for physicians to compare the quality and cost of the care they provide to their Medicare patients with that of other physicians -- with the end goal of achieving practice improvement and bonus payments.

For physicians who didn't access their reports this past September, when CMS first made them available, the FPM article walks readers step-by-step through how to access those documents online.

After gaining online access, carefully following Robertson-Cooper's QRUR navigation tutorial will allow physicians to understand the information contained in the report and put it to best use.

It's important for physicians to understand that the QRURs made available in September contain quality performance data from 2013 and cost data from 2014 -- all of which will be used to calculate a practice's VBPM in 2016 if that practice has 10 or more physicians.

Solo practices and those with fewer than 10 physicians won't be held accountable until 2017 for performance data collected in 2015.

CMS Updates QRUR Information

CMS recently made important announcements regarding the release of its 2014 Quality Resource and Use Reports (QRURs). Information relevant to family physicians was covered in two separate posts published in Family Practice Management's Getting Paid blog.

The Nov. 20 blog entry informs physicians that because of technical issues and problems related to data submitted through electronic health record systems, CMS released revised 2014 QRURs. According to CMS, the corrections will affect Medicare payment for some practices; those practices will be notified.

The Nov. 24 entry notes that in light of the release of updated QRURs, CMS is extending the deadline for physicians to request an informal review of their reports. Practices now have until 11:59 p.m. EST on Dec. 16 to make those requests.

Think ahead and get on board now, Robertson-Cooper advised. "The care you are delivering today can potentially affect your Medicare reimbursement in 2017."

The reports contain a plethora of information and include supplementary tables intended to "allow a deeper dive into the data."

Here's what you can expect to find in your practice's QRUR:

  • performance highlights,
  • benchmarking and risk adjustment that compare a practice's quality and cost measures to peer practices,
  • a quality composite score,
  • a cost composite score, and
  • the application of the VBPM.

Furthermore, know that CMS judges quality and resource use performance in the following areas:

  • effective clinical care,
  • person- and caregiver-centered experience and outcomes,
  • community/population health,
  • patient safety,
  • communication and care coordination, and
  • efficiency and cost reduction.

Real Experience, Unintended Consequences

As a family physician affiliated with two large practices in Lubbock, Texas, Michael Ragain, M.D., has firsthand experience with QRURs.

"Typical of government programs, it's incredibly complex and fraught with difficulty," Ragain told AAFP News. "And it's going to result in pay cuts if physicians don't perform well."

Ragain serves as chief medical officer at the University Medical Center Health System in Lubbock; he's also a professor in the Department of Family Medicine at Texas Tech University Health Sciences Center.

He knows he's fortunate that his clinics have access to a wealth of resources when it comes to dealing with QRURs and other hard-to-grasp government programs. But he worries about those small and solo practices that will be brought into the QRUR program system and held responsible for outcomes beginning in 2017. "They're busy just keeping their heads above water," and many don't have access to resources to help them, said Ragain.

He's also aware of an unintended consequence that could potentially affect patient care.

"If you're holding a physician responsible for the outcome measure of a diabetic A1c, we all know that's really a partnership between the patient and the doctor, and either one of those partners could have failings," Ragain said.

"What happens if you're a doc and a patient walks in, and you can tell from the get-go that the patient is going to be hard to control?" he asked. "There is at least a temptation to say, 'You know, I think you better go see a specialist.'

"In other words, pass the buck -- which is not serving the patient," said Ragain.

"I don't think anyone has a good answer for how you deal with that, but when your pay is connected to that situation, it starts to really hit home," he added.

Bottom line, a program aimed at improving quality and adding value to health care also comes with risks. "It certainly ought to be simpler, but still, it's necessary for family physicians to engage," said Ragain.