This past fall, the Centers for Medicare & Medicaid Services (CMS) made quality and cost reports available to physicians and group practices nationwide for the first time. The Quality and Resource Use Reports (QRURs) provide comparative information about the quality and cost of the care you delivered to your Medicare fee-for-service patients during 2013.
The reports use quality measures from the Physician Quality Reporting System (PQRS) as well as the information you report through PQRS. Your QRUR supplies data for the Medicare patients you "directed" (likely those for whom you were the primary care physician), "influenced" (likely those you treated as a specialist), and/or "contributed to" (all others).
The 2013 QRURs include data assessing a physician's or group's performance on cost measures, information about the services and procedures contributing most to patients' costs, and performance on quality measures including performance on three outcome measures.
CMS intends the QRURs to provide clinically meaningful information you can use to improve quality and efficiency as you care for your Medicare patients. And the QRURs preview the performance scores CMS will use to calculate your value-based payment modifier under a new payment system, set to take effect in 2015 for larger practices and by 2017 for all physicians. The value-based payment system moves toward physician payment that rewards value rather than volume.
Physicians have reported the QRURs are difficult to interpret. For help, you can turn to the TMF Quality Innovation Network Quality Improvement Organization, an offshoot of TMF Health Quality Institute (See “Partner in Quality” in the October 2014 issue of Texas Medicine.).
Under a contract with Medicare, TMF has created several quality networks you can join to get help and consulting at no cost. To get started with PQRS, QRUR, and value-based payment help, join the Value-Based Improvement and Outcomes Network. (And while you're at it, check out the Meaningful Use Network.)
Or, contact these TMF Quality Innovation Network representatives for information:
Project Resource Consultant
To find out more about the QRUR, visit the 2013 QRUR and the How to Obtain the 2013 QRUR webpages on the CMS website.
It's not too late to report to PQRS for the 2014 program year via registry (last day for reporting via PQRSwizard and Covisint PQRS is Feb. 26, 2015) or electronic health records (last day for reporting is Feb. 28, 2015). It's too late to start reporting via claims for 2014 because physicians most likely will not meet all of the reporting requirements.
For an overview of the 2014 PQRS reporting requirements, visit the TMA website or check out TMA's on-demand webinar.
Action, Jan. 5, 2015