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2012 QRUR (disseminated 9/13)


This page contains links to QRUR templates, methodologies, and supporting information for the  Quality and Resource Use Report (QRUR) that CMS issued in September  2013 to physicians in groups of 25 or more elgible professionals. CMS will create new reports and supporting document annually to support the physician value initiative and the value-based payment modifier. On the archive page, we will retain an archive of previous report templates and methodologies.

2012 Quality And Resource Use Report And Physician Quality Reporting System Feedback Report

In September 2013, CMS provided medical group practice-level Quality and Resource Use Reports (QRURs) to 3,876 medical groups. QRURs were provided to all groups of physicians nationwide that include 25 or more eligible professionals that submitted Medicare claims under a single Tax Identification Number (TIN). Three versions of the QRUR template are available, depending upon how the group reported quality data for 2012:

  1. Template for groups that participated in 2012 Group Practice Reporting Option of the Physician Quality Reporting System

    In September 2013, CMS provided medical group practice-level Quality and Resource Use Reports (QRURs) to 67 groups that participated in the 2012 Group Practice Reporting Option (GPRO) of the Physician Quality and Reporting System (PQRS). QRURs were provided to all groups of physicians nationwide that include 25 or more eligible professionals that submitted Medicare claims under a single Tax Identification Number (TIN).

  2. Template for groups that participated in the Medicare Shared Savings Program or the Pioneer Accountable Care Organization (ACO) Model Program

    In September 2013, CMS provided medical group practice-level QRURs to 398 medical group practices that participated  in the 2012 Medicare Shared Savings Program or Pioneer Accountable Care Organization (ACO) Model  (each with 25 or more eligible professionals submitting Medicare claims under a single tax identification number), that participated in the PQRS web-interface group reporting option (GPRO).

  3. Template for groups that were not GPRO or ACO participants.

    In September 2013, CMS provided group-level QRURs to 3,411 medical group practices (each with 25 or more eligible professionals submitting Medicare claims under a single tax identification number) that did not select the PQRS GPRO web interface or registry reporting mechanism but requested that CMS evaluate their quality performance based on 14 administrative claims-based quality measures.

  4. QRUR Drill Down Template
    This template is for the drill down reports that provide detailed information to accompany the 2012 QRURs. A de-identified, sample GPRO medical group practice QRUR is also provided, for reference.
  5. Individual Eligible Professional PQRS Performance Report Template
  6. In December 2013, CMS provided Individual Eligible Professional (IEP) PQRS Performance Reports to all group practices with 25 or more eligible professionals for which at least one eligible professional reported PQRS measures as an individual in 2012 and was found to be PQRS incentive-eligible. Group practices that did not receive a full QRUR in September 2013 may be able to obtain an IEP PQRS Performance Report. These reports show each eligible professional’s performance (Table A.2), as well as a rolled-up group performance on the PQRS measures reported by the group’s eligible professionals (Table A.1).  This template shows de-identified Table A.1 and Table A.2 for a sample medical group practice.
  7. Tips for Understanding and Using the 2012 Quality and Resource Use Report (QRUR) Drill Down Reports for Medical Group Practices
    This document provides tips for how medical group practices can use the drill down detailed reports that accompany the 2012 QRURs to improve quality of care, streamline resource use, and identify care coordination opportunities for one’s beneficiaries.

    Detailed Methodology for the 2012 Quality and Resource Use Reports
    This document provides details of the technical methodology used to produce the 2012 QRURs for medical group practices.

    Changes from 2011 QRURs to 2012 QRURs
    This document provides an overview and enumerates changes in the format and content of the Group QRUR between program year 2011 and program year 2012.  Many changes are the result of feedback and suggestions that CMS received.

    Questions and Answers about the Quality and Resource Use Reports and Individual Eligible Professional PQRS Performance Reports for Medical Group Practices
    This document presents frequently asked questions (FAQs), and answers, that medical group practices may have about the 2012 QRURs, the 2012 IEP PQRS Performance Reports, and the value-based payment modifier (VBM).

    Measure Means and Standard Deviations for the Measures Included in the QRURs
    This document presents the benchmark means and standard deviations for: (1) Physician Quality Reporting System (PQRS) quality indicators for groups not participating in the Medicare Shared Savings Program or the Pioneer ACO model, (2) PQRS quality indicators for groups participating in the Medicare Shared Savings Program or the Pioneer ACO model, and (3) administrative claims-based quality indicators for groups not participating in the PQRS Group Practice Reporting Option (GPRO). For all groups (with 25 or more eligible professionals or with 100 or more eligible professionals), this document also presents benchmark means and standard deviations for care coordination quality indicators, as well as for per capita costs indicators for Medicare beneficiaries attributed to the groups.

    Administrative Claims-Based Quality Measures Included in the Quality and Resource Use Reports for Medical Group Practices
    This document contains narrative specifications for the 14 administrative claims-based quality measures (CBQMs) that were included in the 2012 QRURs.  These measures were assessed for all medical group practices nationwide with 25 or more eligible professionals that submitted Medicare claims under a single Tax Identification Number (TIN) and that were not GPRO or ACO program participants in 2012.

    Drug List for “Use Of High Risk Medications in the Elderly” Measure in the 2012 Group Practice Quality And Resource Use Reports
    This document presents the medication list for one of the 14 administrative claims-based quality measures  that assesses the use of high-risk medications in the elderly.  The claims-based quality measures are used to assess the quality of care provided by groups who are not participating in the GPRO and ACO program.

    Ambulatory Care Sensitive Condition (ACSC) and Care Coordination Outcome Measures for the 2012 Medical Group Practice Quality and Resource Use Reports
    This document presents the narrative specifications for the Ambulatory Care Sensitive Conditions (ACSCs) measures, as well as the all-cause inpatient hospital readmissions measure.  ACSCs are conditions for which good outpatient care can prevent complications or more serious disease. The Agency for Healthcare Research and Quality (AHRQ) developed measures of potentially avoidable hospitalizations for ACSCs as part of a larger set of Prevention Quality Indicators (PQIs). The measures rely on hospital discharge data but are not intended to measure hospital quality. Rather, high or increasing rates of hospitalization for these conditions in a defined population of patients may indicate inadequate access to high-quality ambulatory care. The QRURs present risk-adjusted ACSC admission rates per thousand Medicare beneficiaries attributed to medical group practices, based on six individual measures (for bacterial pneumonia, urinary tract infection, dehydration, diabetes, chronic obstructive pulmonary disease (COPD) or asthma, and heart failure) and two composite measures of hospital admissions. The risk-adjusted all-cause readmissions measure assesses readmissions to an acute care hospital within 30 days of an inpatient hospitalization discharge among Medicare beneficiaries aged 65 years or older.  The admission rates for the ACSC measures and the readmissions measures are calculated from 2012 Medicare Part A claims data.  

        

      The 2012 QRUR Experience Report

The 2012 QRUR Experience Report summarizes the data contained in the 2012 QRURs so that report recipients, policymakers, researchers, and other stakeholders can see:

•       Descriptive information about the characteristics of groups for which CMS produced QRURs (Section II),  including the beneficiaries attributed to these groups and size of groups.

•       The performance, reliability, and statistical significance for all quality (Section III) and cost (Section IV) measures included in the reports.

•       Characteristics of groups with high, average, or low quality or cost scores; the relationship between quality and cost scores; and the relationship between risk adjustment and the composite scores (Section V).

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