The world of medicine and health information technology is full of acronyms. Today I am going shine a light on a relatively new one. The Quality and Resource Use Report (QRUR) is a practice-level report that reflects how well, or not so well, your practice will fair with respect to the looming physician value-based payment modifier. Last week CMS made these reports available to every medical practice in the country. I say made available, but let me assure you retrieving one is not for the faint of heart. It took me about a week to get my hands on the report for my wife’s small internal medicine practice. I like to believe I can navigate these waters reasonably well as this is not my first rodeo so to speak, but perhaps I am just fooling myself. For those of you who have successfully navigated these waters and now have your QRUR in hand, you may want to skip this blog post and move on to bigger and better things.
The hunt for the elusive QRUR begins with the creation of a practice-level Individuals Authorized Access to the CMS Computer Services (IACS) account. Many of you have run this gauntlet before, but if you have not, what follows is as close to a step-by-step approach as I can manage.
Our journey begins simply enough at the registration web site. After agreeing to forfeit your first born child if you violate the CMS security rules, you will have the opportunity to click on the link labeled “New User Registration.” Near the bottom of the column of choices on the left side of the page you will find the link not so clearly labeled as “PV/PQRS Registration System,” which will take you to the next page. Of note, this is not the most stable set of web pages I have visited and several times I received what’s called a 404 server error. This occurred with both Chrome and Internet Explorer. If you see the server error, fear not, just continue to click the link you need and ultimately they will let you in.
Once you arrive on the IACS registration page, you will have the opportunity to register for an account. If you are in a practice with more than one provider and you are the first person in your practice to boldly go where no man has gone before, make sure you elect the “security official” role. If you do not, then tomorrow you will get an email explaining that they cannot locate your practice in IACS. (In all things IACS there appears to be a 24-hour communication delay. Perhaps they are saving tax-payer dollars by using 20-year-old technology.)
To complete your registration, you will need to have several numbers handy:
- The practice’s Tax ID number (TIN)
- The NPI number of each provider in the practice (docs and mid-levels)
- The Provider Transaction Access Number (PTAN) of each provider in the practice
Once you complete the IACS registration, you are ready to log in, right? Not so fast. Remember the 24-hour delay I mentioned? It applies here as well.
QRUR: The moment we have been waiting for
After the earth completes another rotation, with your IACS credentials firmly in hand, you will have the opportunity to log into the CMS Portal. When you are in, look for the yellow drop-down menu in the upper-left corner and select “QRUR-Reports.” On the next page, select the year you are looking for (2013) and the report you would like. The report drop down has several options:
Figure 1: QRUR Report Options
If you have the time, take a look at all of the reports, but of particular interest is the one labeled “Medicare Fee-for-Service Value-Based PY2013 Performance Dashboard,” When you select one of these reports to view, there is yet another nag screen where you must verify you do indeed have the right to see your data. As a member of the practice, the first radio button at the bottom is the one you are looking for (HIPAA Covered Entity). When the page opens, scroll up and click the right-facing arrow to move your report into the queue on the right side of the page, then scroll to the bottom and click “Run Document.” If you are following along at home, you will come to appreciate the lack of user-centered design in this tortuous path!
The dashboard report is a high-level overview of how your practice performed from a cost and quality perspective in 2013. The other high-value target in my view is the one entitled “PY2013 Quality and Resource Use Report.” This is the actual QRUR and EVERY practice should get their hands on this and review it.
Figure 2: QRUR Tabs
The first four tabs in the screen shot above are worth your attention. Print them and save a PDF copy if you can. (That useful piece of functionality was not working while I was logged in.) The security around this thing is understandable, but for those of you who have never had an IACS account before, your password must change every 60 days. When you receive the email asking you to change it, don’t ignore it because they will lock you out and make you run the gauntlet again to reregister.
QRUR and FLAs
Many of you are already familiar with IACS and PTAN, but let me assure you, QRUR is a four-letter acronym (FLA) that is well worth your attention. CMS is planning to provide greater clarity during an upcoming MLN Connects call.
As the world around us slowly transitions from a payment system that rewards volume to one that pays for value, you need to understand how you are being measured. The QRUR is a guidepost that provides insight into the complexities of the physician value-based payment modifier. Do yourself a favor and make sure someone in your practice runs the gantlet I’ve outlined above, and if time permits, listen in on the upcoming MLN Connects call. It will indeed be time well spent.