QRUR resources
www.texmed.org/GuidetoMedicare ValueBasedCare.) But the information is especially important, as the work physicians do now determines bonus- es or penalties in their payments two years down the line. The release coincides with Medi-
TMF Health Quality Institute: QRUR Inter- pretation and Quality Improvement Guide
www.texmed.org/ QRURguide
TMF: Value-Based Improvement and Out- comes Network tma.tips/TMFNetwork
Centers for Medicare & Medicaid Services (CMS): How to Obtain a QRUR tma.tips/HowTo ObtainaQRUR
CMS: Value-based payment modifier fact sheets tma.tips/CMS ValueModifier
care’s implementation of the value modifier, which adjusts physician payments based on the quality data they report to the Physician Qual- ity Reporting System (PQRS) and on Medicare cost data, all from two years prior. Payments to large practices face adjustments this year based on 2013 quality and cost data. The 2015 data will determine payments for all physi- cians in 2017 and beyond. (See “Value- Based Payment Modifier Takes Effect,” page 62.) TMA officials say the QRURs also
help set expectations for what’s to come under MIPS, which Congress created when it eliminated the Medi- care Sustainable Growth Rate (SGR) formula in April under the Medi- care and CHIP Reauthorization Act of 2015. (See “R.I.P. SGR,” June 2014 Texas Medicine, pages 26–37, or visit
www.texmed.org/RIPSGR.) Under the new payment paradigm, Medi- care’s three main quality reporting programs — PQRS, the value modi- fier, and meaningful use of electronic health records (EHRs) — remain in effect through 2018. Starting in 2019, MIPS will combine them into a single value-based program that continues to assess physician performance and payment based on quality, utilization, clinical practice improvement activi- ties, and EHR use.
CRITICAL FEEDBACK “The QRURs give physicians a window into their current performance and how they may fare in the future,” says Tracy Swoboda. She oversees value- based payment initiatives as project director for TMF’s most recent con- tract as the state’s quality improve- ment organization. “The purpose of the methodology is to help physicians understand their performance and
60 TEXAS MEDICINE July 2015
identify practice opportunities for im- provement,” she said. The reports give information on:
• PQRS quality measures submitted via claims, registry, or EHRs;
• Other claims-based quality mea- sures CMS uses for the value modi- fier; and
• Medicare cost measures, such as hospital admissions or condition- specific costs.
The QRUR scattergram depicts an
overview of how physicians compare with their peers and whether they fall above, below, or within average in terms of cost and quality. An overall quality score reflects
physician performance in measures derived from as many as six quality categories — called domains — estab- lished under CMS’ National Quality Strategy:
• Clinical process/effectiveness, • Patient and family engagement, • Population/public health, • Patient safety, • Care coordination, and • Efficient use of resources.
Not all physicians will have scores
for all domains, depending on which measures they choose to report. An overall cost score summarizes
how practices fare on utilization across two cost categories, or do- mains: per-capita costs for all attrib- uted Medicare patients and per-capita costs for patients with specific chronic conditions — diabetes, coronary artery disease, chronic obstructive pulmo- nary disease, and heart failure. Ms. Swoboda acknowledges the ta-
bles and calculations can be daunting, which is why TMF offers the QRUR Interpretation and Quality Improve- ment Guide to help physicians not only interpret the findings but also act on them. Physicians also can join TMF’s online Value-Based Improvement and Outcomes Network to get no-cost technical assistance with Medicare’s
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68