2015 Supplemental QRURs and Episode-Based Payment Measurement

Section 3003 of the Affordable Care Act (ACA) of 2010 requires that the Secretary of the Department of Health and Human Services (HHS) develop an episode grouper. CMS is applying episode grouping algorithms specially designed for constructing episodes of care in the Medicare population. An episode of care (“episode”) is defined as the set of services provided to treat a clinical condition or procedure.

2015 Supplemental QRURs

The Supplemental Quality and Resource Use Reports (QRURs) are confidential feedback reports provided to medical group practices with payment-standardized, risk-adjusted cost information on the management of their Medicare fee-for-service (FFS) patients based on episodes of care. The Supplemental QRURs are currently for informational purposes only and complement the per capita cost and quality information provided in the QRURs. In the fall of 2016, CMS made 2015 Supplemental QRURs available to all group practices and solo practitioners. The information included in the 2016 Supplemental QRURs is not incorporated in the Value-based Payment Modifier (VM) under the Medicare Physician Fee Schedule.

2015 Supplemental QRURs

(Click on the underlined section headers to view the related document)

Detailed Methods, 2015 Supplemental QRURs (PDF)  

This document presents the detailed methodology for the 2015 Supplemental QRURs, including an introduction to the goals and content of the reports.

Frequently Asked Questions (FAQs) Regarding the 2015 Supplemental QRURs (PDF)  

This document presents responses to frequently asked questions (FAQs) about the 2015 Supplemental QRURs and the methodology used.

Tips for Understanding and Using the 2015 Supplemental QRURs (PDF)  

This document provides tips on how groups and solo practitioners can use the 2015 Supplemental QRUR to understand their performance and identify opportunities for improvement.

Episode Definitions (2015) (ZIP)  

These files contain episode definitions that provide clinical descriptions and individual codes used to trigger and group Medicare claims into episodes for the 2015 Supplemental QRURs.

NPC Presentation & Addendum (ZIP)  

This file contains the October 20^th National Provider Call (NPC) presentation for the 2015 Supplemental QRURs, titled “How to Interpret Your 2015 Supplemental Quality and Resource Use Report (QRUR)”, and an addendum that provides a high level summary of the data contained in the reports.

Sample 2015 Supplemental QRUR (ZIP)  

This file contains a sample 2015 Supplemental QRUR in two parts: a PDF file for Exhibits 1-4 and an Excel file for the Drill Down Tables.

Instructions for Medical Group Practices and Solo Practices to Access the 2015 Supplemental QRURs (PDF)  

This document gives instructions to group practices and solo practices on how to access their 2015 Supplemental QRUR.

Authorized representatives of group and solo practitioners can access the 2015 Supplemental QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role.  For more information on how to access the 2015 Supplemental QRURs, please see the “Instructions for Medical Group Practices and Solo Practices to Access Their 2015 Supplemental QRURs”, available for download in the hyperlink above.