1. 2015 Annual Quality Resource Usage Reports (QRUR)
Don Gettinger, Quality Data Reporting Manager
Qsource - Indiana

2. Why is the QRUR Important?
The QRUR displays your 2015 Physician Value Modifier performance which can positively or negatively affect Medicare Part B Physician Fee Schedule reimbursement in 2017.
The 2016 Physician Value Modifier Program is based on performance during the 2016 calendar year and will affect Medicare reimbursement in 2018.
The QRUR is the best source of your current Cost and Quality performance that make up 60% of your 2017 MIPS score. While cost is not part of the 2017 MIPS score, it will be included in future years.

3. Policies for the 2017 VM
2015 is the performance year for the application of the 2017 VM.
Applies to all physicians in groups with 2+ eligible professionals (EPs) and to physician solo practitioners, as identified by their Medicare-enrolled Taxpayer Identification Number (TIN), including those that participated in the Shared Savings Program in 2015.
Based on participation in the Physician Quality Reporting System (PQRS) in 2015.
VM is waived for a TIN if at least one EP who billed for Medicare Physician Fee Schedule (PFS) items and services under the TIN during 2015 participated in the Pioneer Accountable Care Organization (ACO) Model or Comprehensive Primary Care (CPC) initiative in 2015.

4. What is the 2015 Annual QRUR?
Shows how TINs performed in 2015 on quality and cost measures used to calculate the 2017 VM.
For TINs subject to the 2017 VM, the QRUR shows how the VM will apply to physician payments under the Medicare PFS for physicians who bill under the TIN in 2017.
Based on all services provided from January 1, 2015 through December 31, 2015.Cost, claims-based outcome measures, and utilization data is based on all services provided to a TIN’s attributed patients.
Quality data is based on PQRS quality data submitted by the TIN.

5. Who received a 2015 Annual QRUR?
All TINs nationwide that had at least one EP bill Medicare under the TIN in 2015 received a full QRUR, including TINs that participated in the Shared Savings Program, Pioneer ACO Model, or the CPC initiative in 2015.
TINs that did not have at least one EP bill Medicare under the TIN in 2015 received a one page report.

6. How to Access the 2015 Annual QRUR
An EIDM account is required to access the QRUR.
You can sign up for a new EIDM account, modify an existing EIDM account to add the correct role, or reset an EIDM account password (every 60 days) on the CMS Enterprise portal at
If you want to know whether there is already someone who can access your TIN’s QRUR Contact the QualityNet Help Desk (phone: or and provide the name and number of the TIN.

7. How can I access my QRUR?
Go to and select “Login to CMS Secure Portal”
Accept the Terms and Conditions and enter your EIDM User ID and Password

10. Information Contained in the 2015 Annual QRUR

11. Cover Page

12. Exhibit 1. 2017 VM Payment Adjustments under Quality-Tiering
Exhibit 1 displays the 2017 VM calculated for your TIN.
Note: TINs with 10 or more EPs will receive a +2.0 x AF upward adjustment for having High Quality/Average Cost. An additional upward adjustment of +1.0 x AF was applied to this TIN, because it achieved that designation and treated a high proportion of clinically complex beneficiaries

13. What quality measures are used to calculate the Quality Composite Score?
This section of the QRUR describes the quality measures used to calculate your TIN’s Quality Composite Score.
Exhibit 3 shows your TIN’s performance on the quality measures, by domain, used to calculate the Quality Composite Score.
Each of the six National quality Strategy domains that have measures reported are equally weighted to calculate the Quality Composite Score

14. PQRS Reported Quality Measures

15. CMS calculated Quality Measures

16. Exhibit 4. Your TIN’s Cost Composite Score
Exhibit 4 shows your TIN’s Cost Composite Score, which reflects its overall performance on cost measures compared to its peer group.

17. Cost Composite Score All Attributed Beneficiaries Domain (2 measures)
Per Capita Costs for All Attributed Beneficiaries
Medicare Spending per Beneficiary
Beneficiaries With Specific Conditions Domain (4 measures)
Per Capita Costs for Beneficiaries with Diabetes
Per Capita Costs for Beneficiaries with Chronic Obstructive Pulmonary Disease
Per Capita Costs for Beneficiaries with Coronary Artery Disease
Per Capita Costs for Beneficiaries with Heart Failure

18. Cost Composite Score

19. Attribution
The CMS Calculated Quality and Cost measures are based on patients attributed to your TIN through a two step attribution process. Every Medicare beneficiary is attributed to a single TIN.
Step 1 – The beneficiary will be attributed to the TIN that provided the most primary care services from primary care clinicians.
If no primary care services were provided by any primary care clinician then the beneficiary would be attributed to a TIN by step 2
Step 2 - The beneficiary will be attributed to the TIN that provided the most primary care services from specialist clinicians
Step 1: A beneficiary is attributed to a TIN in the first step if the beneficiary received more primary care services from primary care physicians4 (PCPs), nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs) in that TIN than from those in any other TIN. Primary care services include evaluation and management services provided in office and other non-inpatient and non–emergency-room settings, as well as initial Medicare visits and annual wellness visits. If two TINs tie for the largest share of a beneficiary’s primary care services, then the beneficiary is assigned to the TIN that provided primary care services most recently.
• Step 2: If a beneficiary did not receive a primary care service from any PCP, NP, PA, or CNS during the performance period, then the beneficiary is attributed to a TIN in the second step if the beneficiary received more primary care services from specialist physicians within the TIN than in any other TIN.

20. Attribution
Attribution for the CMS Calculated Medicare Spending per Beneficiary cost measure uses a different process than the other CMS calculated measures.
CMS attributes MSPB episodes to the one TIN responsible for the plurality of Part B services, as measured by Medicare allowed amounts, performed by eligible professionals during the episode’s index hospitalization.
A list of attributed Medicare beneficiaries for all measures except the MSPB measure can be found in supplementary Table 2A
A list of attributed Medicare beneficiaries for the MSPB measure can be found in supplementary table 5B

21. Action Items
Review your 2016 Annual QRUR to ensure there are no errors. This report should be released in September of 2017.
Ensure your TIN successfully submits PQRS measures for 2016 (Hopefully this is already done!)
Look at your quality dashboard to make sure your quality measure performance is accurate and as good as possible.
If you note that patients are being inappropriately attributed to specialists, consider making referrals to primary care physicians.

22. Questions & Discussion

23. Quality Data Reporting Manager
Don Gettinger
Quality Data Reporting Manager