Quality BY AMY LYNN SORREL
Technical assistance required
NEW MEDICARE QUALITY REPORTS GIVE PHYSICIANS CRITICAL FEEDBACK BUT MAKE IT DIFFICULT TO INTERPRET
T
he new quality feedback reports Medicare released last fall finally give all physicians actionable data to gauge their performance in the vari- ous federal quality reporting mandates and to measure the impact of
the programs on their practices in a fast-approaching value-based care system. But doctors say they should come with a warning label: “Technical Assis-
tance Required.” The Quality and Resource Use Reports (QRURs) provide detailed informa-
tion on physicians’ quality and cost performance and how they compare with their peers. Because those scores feed directly into how Medicare now calcu- lates payment penalties under the value-based payment modifier — and eventu- ally will determine financial bonuses and penalties under the new Merit-Based Incentive Payment System (MIPS) — the information is critical, says Texas Med- ical Association Council on Health Care Quality member Michael Ragain, MD. The family physician and chief medical officer at University Medical Center
Health System in Lubbock saw from his group’s report that the doctors faced a potential penalty this year, and they were able to make adjustments in time to avoid it. “It’s really the first time we actually had that kind of clinical data feedback,”
Dr. Ragain said. But to unravel the mystery of scattergrams and composite scores, he had to
get help from TMF Health Quality Institute, the Medicare-contracted statewide quality improvement organization and network. “Medicare is moving this direction [toward value-based care] like a freight
train. But even for a large group practice like ours, it’s very complex. It’s very confusing. And it’s very overwhelming,” Dr. Ragain said. “Simplification would be greatly appreciated.”
PARADIGM SHIFT At medicine’s urging, the Centers for Medicare & Medicaid Services (CMS) be- gan releasing the confidential QRURs to all Medicare physicians treating fee- for-service patients. Previously, they were available only to large groups because they were the first ones subject to the value modifier. CMS’ initial wide-scale distribution of QRURs in September 2014 contains 2013 quality and cost data, and Medicare plans to release the reports at least annually, each fall, with data from the prior year. The QRURs may add another enigmatic acronym to the alphabet soup of
quality reporting mandates to which physicians are now held. (See “Your Guide to Medicare Value-Based Care,” April 2014 Texas Medicine, pages 26–34, or visit
July 2015 TEXAS MEDICINE 59
“We all want quality, and I want to know if I’m in the ballpark and
if I’m doing the right thing. But CMS makes it impossible for me to find out.”
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