The Quality and Resource Use Report: How will your practice get paid?

By TMF Health Quality Institute

According to the Centers for Medicare and Medicaid Services, Quality and Resource Use Reports provide comparative information so that physicians, either in a group or individual practice setting, can view examples of the clinical care their patients receive in relation to the average care and costs of other physicians’ Medicare patients. These reports — often referred to as QRURs — are similar to a report card, with the end goal being to achieve practice improvement and bonus payments. Ultimately, the report will suggest how solo practitioners and groups will perform under the Value-Based Payment Modifier program.

How a physician or physician group will fare depends on the quality of care they provided and the cost, or resource use, for those services, which will adjust a physician’s or group’s Medicare payment under the Value-Based Payment Modifier program. Reviewing and learning to understand the QRURs now will help solo practitioners and groups learn in which areas they need to improve.

QRURs are generated for all solo practitioners and groups nationwide, as identified by their Taxpayer Identification Number. These reports are confidential. QRURs can be used to see how your practice compares with others caring for Medicare beneficiaries. Recently, the 2015 Mid-Year QRURs were released. However, mid-year reports are not comprehensive and may change somewhat when the annual report is released in the fall. Be sure you have access to view the 2015 Annual QRUR when it is released in the fall of 2016. This will be used to calculate your value modifier score and effect payment for 2017.

For more information on QRURs, go to www.cms.gov, click on Medicare at the top, and go to Medicare Fee-for-Service Payment section. From there you can find information on how to obtain a QRUR plus the following documents:

• How to Obtain a QRUR
• Quick Reference Guide for Accessing the 2015 Mid-Year QRURs and Tables
• How to Understand your 2014 QRUR and Supplementary Exhibits
• Sample 2014 Annual QRUR
• FAQs about QRURs and the 2016 Value Modifier

The TMF Quality Innovation Network is hosting upcoming events for the benefit of physicians and hospital health care professionals. You can learn more by visiting www.TMFQIN.org and clicking on the Events tab.