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Prepare for the release of Physician Quality Reporting System (PQRS) reports and Qualtiy and Resource Use Reports (QRUR), which provide important information on payment adjustments for 2017 and improvement opportunities. They will be released by CMS any day now.

PQRS feedback reports depict your program year 2015 PQRS reporting results, including payment adjustment assessment for 2017.

QRURs are how a practice obtains comparative information about the quality and cost of the care provided to Medicare patients. QRURs should be used to:

  • Verify the accuracy of EPs billing under your group’s Tax Identification Number (TIN).
  • Examine the number of patients attributed to your group and the basis for the attribution.
  • Evaluate how your group’s performance compares to other groups and which attributed beneficiaries are driving your group’s cost and quality measures.
  • Show how providers will fare under the 2017 Value-Based Modifier (VM)

Use the data to determine which EPs successfully reported PQRS and which didn’t, so you can reach-out to provide assistance to those that are struggling.  Discover which providers reported each measure and how their scores may have affected your quality score.  Identify high performers to learn best practices.  Identify low performers to target areas for improvement. 

Develop processes to improve the measures, which may involve better data capture, improved communication between specialists and primary care, template development; development of protocols of care; assignment of duties to various members of the care team so preventive and other care is consistently delivered.

If you’re not happy with your performance, here are some best practices that organizations can follow to improve quality and thus their scores.

  • Designate a person to run QI reports
  • Target high-risk patients identified in QRUR
  • Run lists of patients by diagnosis and identify care gaps
  • Provide dedicated time to work on improvement
  • Design workflows for population management
  • Have coders study measure specifications to ensure reporting is correct; code robustly
  • Establish care coordination process for high-risk patients
  • Establish transitions of care process with hospitals, home health, skilled nursing facilities, specialists for “warm handovers”
  • Adopt protocols of care
  • Establish better communication and reports with specialists. Here are five ideas to start.

PQRS//Value Modifier: Ensure your EIDM account is active and working, log into the CMS Enterprise Portal to verify.  If you do not have an EIDM account, create one now as the process can take several weeks.  The EIDM account will allow you access to the PQRS Feedback and QRUR reports.

Primaris Quality Improvement Managers Jennifer Wilbers and Lisa Hays will be hosting an upcoming open forum webinar on 2016 PQRS and Meaningful use. This open forum event will cover upcoming changes related to meaningful use and PQRS. You will have the opportunity to ask questions and interact with peers as well as TMF Quality Innovation Network consultants.

Registration Instructions

  1. Go to the event page.
  2. Click "Register."
  3. Fill out the required information. 
  4. Click "Submit."
  5. Once approved, you will receive a confirmation email from messenger@webex.com with the meeting and login information to use on the day of the event. Keep this email.  Add this event to your calendar.

Investing in quality is essential if you want to succeed in value-based healthcare.  Download the free eBook, “5 Steps for Financial Success in a Value-Based Payment Environment,” and use it to maximize operational efficiency and improve healthcare quality.

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