MACRA Preparedness: Understanding Your QRUR

Organizations are wondering how they can predict their performance under the Quality Payment Program’s MIPS pathway. The answer is actually the same as it was for gauging performance under the PQRS and the Value-Based Modifier programs – CMS’ Quality and Resource Utilization Report (QRUR). We find that most organizations have similar, basic questions: What is QRUR? What does it do? How can it be obtained? What does it have to do with MACRA? Some answers…

What is the QRUR?

CMS developed the QRUR to provide quality and cost performance feedback to PQRS and Value-Based Modifier (VBM) participants. The report offers comparisons between individual TIN (Tax ID Number) participant measure performance against national benchmarks. The performance comparison then determines whether TIN members receive positive, neutral, or negative payment adjustments.

QRURs are generated mid-year (solely for informational purposes) and annually (to create payment adjustments). The annual 2015 QRUR was released in September 2016, reporting calendar year 2015 performance and determining 2017 VBM payment adjustments.

Why haven’t I heard of the QRUR?
Probably because the QRUR does not magically appear in your practice – you have to actively go get it. Since most PQRS participants solely focused on reporting measure data before the deadline, most participants have not been especially concerned with their actual performance – or improving their actual performance. PQRS is a pay-for-reporting program (or, since 2015, reporting to avoid a penalty), so improving performance was not really an objective. Therefore, PQRS participants found no reason to go out of their way to see how they were doing or how they might improve their results.

The pay-for-performance element was introduced by the Value-Based Modifier program, which adjusted Medicare payments based on measure performance. The impact was felt in a graduated fashion starting with 2015 payments for groups >100 eligible professionals, 2016 payments for groups >10 eligible professionals, and 2017 payments for the smallest groups (solo and >2). Concern about actual measure performance is a relatively new concept, with many physicians not experiencing the painful surprise of negative payment adjustments until very recently.

What information does the QRUR provide?
As noted above, the QRUR provides individual participating TIN’s VBM data compared to national performance benchmarks across the applicable quality and cost measures. The national mean for a given measure is referenced at zero and the participating TIN’s performance is noted as standard deviations from the mean – positively or negatively.

In addition to directly comparing performance across the quality and cost measures at the TIN level, the QRUR and associated tables provide information at the individual provider and beneficiary levels. If drilled down and dissected, the data can provide insight into opportunities for improving quality of care, streamlining resource use (both for you and the other providers involved in the patients’ care), and enhancing care coordination. And high performers can use the QRUR comparison data to market their practice and negotiate better payer contracts (including direct contracting efforts).

Not all organizations (TINs) have significant data on their QRUR or contribute to the benchmark determinations. For instance, organizations that participated in the Pioneer ACOs, the Comprehensive Primary Care initiative, and some of the MSSP ACOs are excluded/ exempt from these programs, so data may not be present.

How can I get my QRUR?
Each organization (TIN) must request its own report through the following CMS link: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/obtain-2013-qrur.html . A specifically authorized individual must request access. However, the report and associated tables can be downloaded onto Excel spreadsheets for internal use.

What does the QRUR have to do with MACRA?
First, recall that most MIPS Quality and Cost measures are carry-overs from PQRS and VBM. The QRUR provides a TIN’s historic performance on these measures and compares them to the aggregate national performance for the measures. While not an exact replication of the MIPS scoring process, the performance comparison will at least provide a semi-quantitative, directional indication of the TIN’s prior performance.

Second, in-depth QRUR review can inform a performance improvement program that will be crucial to improving performance under MIPS.

Third, the feedback is as good as it gets for at least the first (and probably second) year of MIPS. MACRA and the Quality Payment Program regulations require CMS to provide feedback about provider performance each year – similar to the PQRS, VBM mandate. The first MACRA performance report is due to be released in July 2017 and will actually be the 2015 annual QRUR (since no MIPS data will have yet been submitted/available). It is anticipated that the 2016 QRUR will be released in September 2017 and form the basis of provider feedback heading into 2018. In other words, becoming familiar with the QRUR will be helpful now and for the foreseeable future.

Where can I find more information about the QRUR?
CMS provides significant information about the QRUR on its website. A particularly good resource is Understanding Your QRUR obtainable at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-UnderstandingYourQRUR.pdf .

In addition, many specialty organizations offer insight and assistance. For instance, the AAFP provides a series of webinars and QRUR-related articles through https://www.aafp.org (search QRUR resources).

Finally, HSG stands ready to help you understand the QRUR and how it might fuel a performance improvement program heading into MACRA participation. In addition, our expert team of data analysts can sift through the mountain of data and unearth specific opportunities for improvement.

Let us know how we can be of help. Contact Terry McWilliams, M.D., Chief Clinical Consultant, TMcWilliams@HSGadvisors.com or 502.614.4292.