2011 QRUR (disseminated 12/12)

This page contains links to QRUR templates, methodologies, and supporting information for two versions of the Quality and Resource Use Report (QRUR) that CMS issued in December 2012: to individual physicians in nine states and large groups of physicians that participated in the PQRS Group Reporting Option (GPRO) in 2011. 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.

QRURS for Medical Group Practices
(Click on the underlined section headers to view the related document)

Medicare Fee-For Service 2011 Quality and Resource Use Report and Physician Quality Reporting System Feedback Report (template for 2011 QRUR for Medical Practice Groups) (PDF)
In December 2012, CMS provided group-level QRURs to 54 large medical practice groups (each with 200 or more physicians submitting Medicare claims under a single tax identification number), that participated in the PQRS web-interface group reporting option.

Detailed Methodology for the 2011 Medical Group Practice Quality and Resource Use Reports (PDF)
This document provides details of the technical methodology used to produce the 2011 QRURs for medical practice groups.

Ambulatory Care Sensitive Condition (ACSC) and Care Coordination Outcome Measures for the 2011 Medical Group Practice Quality and Resource Use Reports (PDF)
Ambulatory Care Sensitive Condition (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 group-level QRUR presents ACSC admission rates per thousand Medicare beneficiaries attributed to medical group practices, for diabetes (a composite measure), chronic obstructive pulmonary disease or asthma, heart failure, and acute conditions (a composite measure). The admission rates are calculated from 2011 Medicare Part A claims data.

Physician Quality Reporting System (PQRS)
Link to CMS webpages covering the PQRS program and information about how medical practice groups can self-nominate and participate as a group during calendar year 2013.

Changes in the QRURs for Medical Practice Groups between Program Year 2010 and Program Year 2011 (PDF)
This document provides an overview and enumerates changes in the format and content of the Group QRUR between program year 2010 and program year 2011. Many changes are a result of feedback and suggestions that CMS received.

How PQRS Quality Data Are Used in 2011 Group QRURs (PDF)
In addition to displaying scores for the 26 PQRS quality indicators that each group submitted as a participant in PQRS, CMS has used both group and individual PQRS data in creating a national benchmark for each measure.
For this reason, the percentile distribution of all 55 medical group practices that participated in the 2011 PQRS group reporting option and the average performance of all PQRS physicians may differ from comparative data in 2011 PQRS reports.

QRURs for Individual Physicians Practicing in Groups
(Click on the underlined section headers to view the related document)

QRUR Template for Individual Physicians (PDF)
From December 17, 2012 until at least April 2013, physicians practicing in nine states (California, Illinois, Iowa, Kansas, Michigan, Missouri, Minnesota, Nebraska, and Wisconsin), within a group of 25 or more eligible professionals were able to obtain their QRUR for 2011 from a secure website: www.qrurinfo.com.  This website is no longer accessible.

Methodology for the 2011 Individual Physician Quality and Resource Use Reports (PDF)
This document provides technical details of the methodology used to produce the current QRURs for individual physicians.

Physician Quality Reporting System (PQRS)
Link to CMS webpages covering the PQRS program and information for individuals about participating in PQRS.

Narrative Specifications for 28 Claims-Based Quality Measures Included in the PY2011 Quality and Resource Use Reports (PDF)
Descriptions, numerators, and denominators of the 28 claims-based quality measures, reported in the current QRUR for individual physicians in nine states are included in this document.

Measure Specifications and Drug List for “Use of High Risk Medications in the Elderly” Measure in the 2011 Individual Physician QRUR Reports (PDF)
This CMS-calculated administrative claims-based measure (NQF # 0022) has two rates: 1) Medicare beneficiaries >_ age 65 who received at least one high-risk medication and 2) Medicare beneficiaries >_ age 65 who received at least two high-risk medications. The denominator used to calculate each rate is limited to Medicare beneficiaries >_ age 65 who had Medicare Part D drug coverage during the performance year. This document is a list of medications and dosages that support calculation of the numerator for both rates of this measure.

Changes in the QRURs for Individual Physicians between Program Year 2010 and Program Year 2011 (PDF)
This document provides an overview and enumerates changes in the format and content of the Individual QRUR between program year 2010 and program year 2011. Many changes are a result of feedback and suggestions that CMS received.

2011 Individual QRURs – How PQRS Data Are Used (PDF)
In addition to displaying a physician’s own performance on PQRS quality measures, individual physician performance is compared to all PQRS incentive eligible professionals who submitted the same quality measure. Physicians often have more than one PQRS quality score. When that is the case, the highest score, with the largest denominator (patients who received the recommended intervention) is determined for each carrier under which the physician reported quality data. If PQRS data were submitted for the same physician under more than one carrier, CMS sums all numerators and all denominators for the same measure to compute an all-carrier performance rate. Comparative rates, comprised of all PQRS individuals who reported a measure, are individually weighted by the number of each participant’s beneficiaries who were eligible for the measure.