News and Announcements

Medical Practice Group QRURs

In December 2012, 54 large group practices received a Quality Resource Use Report (QRUR) with comparative performance data for calendar year 2011. The 54 medical practice groups, each with at least 200 eligible professionals who share a single tax identification number (TIN), received group-level QRURs. The groups had each chosen to participate in the CMS Physician Quality Reporting System (PQRS) Group Reporting Option (GPRO) during 2011.

Physician Level QRURs

From December 2012 through at least April 2013, physicians who participated in Fee-for-Service Medicare during 2011 and who practiced for the entire year in one of nine states can get a QRUR.  For the second year, individual Medicare Fee-For-Service physicians practicing in: Iowa, Kansas, Missouri, and Nebraska can download an individual-level QRUR. In addition, physicians serving Medicare FFS beneficiaries in Wisconsin, Minnesota, Michigan, California, and Illinois will receive QRURs.

Opportunity for Input
We will reach out to physicians practicing in the nine states listed above and the 54 medical practice groups, to share information about the Physician Feedback Program, the Value-Based Payment Modifier, and our plans for producing reports in coming years. CMS will invite recipients of the QRURs to participate in conference calls: to offer comments and ask questions about the performance reports and our plans to move toward implementation of the Value-Based Payment Modifier mandated by the Affordable Care Act.

What Should You Do in 2013?

• Participate in PQRS quality reporting.  In calendar year 2013, medical practice groups of 100 or more eligible professionals (all of whom file Medicare Fee-For-Service claims under the physician fee schedule using a single tax identification number) must register and participate in PQRS as a group in order to avoid a negative one percent payment adjustment (in 2015) under the value modifier.
• If you practice in a group of 100 or more eligible professionals, your group will need to self-nominate/register to report quality measures in one of three ways.  From December 1, 2012 through January 31, 2013, groups can self-nominate to participate in the PQRS web-interface group reporting option or the group registry option. Beginning again in July and lasting until mid-October, CMS will continue the self-nomination/registration process for groups of 100 or more eligible professionals to tell us which of the three mechanisms of group reporting they will use for 2013 to avoid a negative 1% payment adjustment under the value modifier.
• During a second self-nomination/registration period (July-October 15, 2013) groups of any size, as well as individual eligible professionals can request that CMS calculate their quality performance based on administrative claims.  The CMS-calculated administrative claims reporting option requires no effort beyond signing up. Large groups (with 100 or more eligible professionals billing under a single TIN) can avoid both a negative 1% value modifier fee adjustment and avoid a negative  1 .5% PQRS payment  adjustment in 2015. For small groups and individuals, signing up for the CMS-calculated administrative claims reporting  option will also avoid a negative payment adjustment in 2015 that would be imposed for not participating in PQRS. In 2013, neither individuals nor groups of fewer than 100 eligible professionals are subject to the value modifier. Small groups and eligible professionals choosing the CMS-calculated administrative claims reporting option would use the same July-October 2013 self-nomination process as large groups. Please note, groups and individuals who sign up for the CMS-calculated administrative claims reporting option will not earn a PQRS incentive payment. 
• Individual reporting of PQRS measures does not meet the requirement for group participation in PQRS (even if every member of the group participates). If individuals choose to participate in PQRS at the individual level in order to earn a payment incentive, the group, as a whole, must still/also sign up in 2013 for one of the three PQRS group reporting options that will allow the group to avoid a negative 1% payment adjustment under the value modifier in 2015.
• During the second sign up period (July-October), large groups that are subject to the value modifier also will have an opportunity to elect a Quality Tiering option to calculate the 2015 value modifier for their group, based on quality and cost performance in 2013. In most cases the result of electing quality tiering (which is voluntary in 2013) would be a neutral value modifier (with no impact on payment).  High quality and low costs could result in a positive value modifier and an upward adjustment in 2015 payments. Conversely, if quality was low and costs were high, the result could be negative payment adjustments of 1%. Not signing up for PQRS group reporting would result in a negative 1% payment adjustment for groups that are subject to the payment modifier, regardless of whether or not the group elected quality tiering.
• Some of the information in the QRURs and posted on Physician Compare is based on how you describe your specialty, practice, and location in the Provider Enrollment, Chain and Ownership System (PECOS). Update all information about you and your practice in PECOS. Go to https://pecos.cms.hhs.gov/pecos/login.do.
• When you receive a confidential QRUR, review it and help us improve future reports by offering input and suggestions.