Issue Background

Quality and Resource Use Reports

Quick Summary

  • QRURs show physicians their comparative performance on quality and cost measures.
  • It is critical for physicians to learn how to access and read these reports because they are used by CMS to calculate Medicare payments.
  • CMS provides a number of tools to assist physicians on accessing and interpreting their QRUR reports, and how to file appeals for incorrect assessments.

What is a QRUR?
Quality and Resource Use Reports (QRURs) are feedback and benchmarking tools provided by CMS as part of the Physician Feedback Program. They offer information about the costs and quality of care provided by physicians or groups to certain Medicare patients.

Each report includes performance information from the Physician Quality Reporting System (PQRS) quality measures, claims-based outcome measures, and claims-based cost measures and then compares it to similar size peer groups.

Two types of QRURs are available.  The first is a mid-year report which provides an informal preview to physicians and physician groups on their quality and cost performance to assess strategic adjustments. The second is the annual QRUR which provides official information about quality and cost performance from the previous calendar year, which is used to calculate payment adjustments.

Why is this Important?
The Affordable Care Act also authorized CMS to use some of the information in the QRURs to calculate the Physician Value-Based Payment Modifier (VBPM / VM), which is used to factor neutral, increased, or decreased payments.

As of 2015, all physicians and group practices are already subject to the VM for their 2017 evaluation and reimbursement. The final amount is based on a composite score of metrics they reported under the Physician Quality Reporting System (PQRS) in 2015, and multiple other quality and cost metrics that CMS calculates based on claims.

QRURs also give physicians the opportunity to view how CMS evaluated their peformance in order to file for an Informal Review during the 60-day response period if they feel they have been incorrectly assessed.

Accessing Your QRUR
QRUR reports can be accessed by logging in at the CMS Physician Value Portion of the CMS Enterprise Portal website, http://portal.cms.gov.

To login, the provider or a designated user will first need to obtain an Enterprise Identity Management System (EIDM) account from CMS. Information on setting up an account and troubleshooting access is available on CMS's Medicare Website.

Interpreting a QRUR
Once you have access to your report, the QRUR is broken down into three main sections.  The first is a Performance Highlights graph section that includes composite visual representations of your quality and cost scores, and a scatterplot of how you compare to your peers.

The scatterplot also shows what CMS considers average scores, delineated within a yellow cross, as well as positive payment adjustment scores in the High Quality/Low Cost Quadrant, and negative payment adjustment scores in the Low Quality/High Cost Quadrant.

The other two sections are more detailed breakdowns of your performance (or the group's performance) on quality and cost measures.

CMS provides a number of resources for physicians to help evaluate the QRUR and its impact.  These resources can be found below.

Additional Physician QRUR Resources

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