It’s that time of year again where everyone eagerly awaits their “Report Cards” from CMS; in other words, the Quality & Resource Use Reports (QRUR)  are coming!  Most folks don’t even know the reports come directly from CMS via their EIDM account, NOT from their registry or EMR vendor. So, let’s start by getting everyone to understand where to get these “report cards” and, once you know how to obtain them, what they mean for you and your practice!

Again, access to the QRUR reports is via your EIDM account with CMS, not with your registry or EMR vendor.  CMS does not forward results of PQRS/QCDR submissions to your registry or EMR vendor. They won’t know how you performed unless you send them these reports.  

What is an EIDM account anyway?  The Enterprise Identity Management System- EIDM, is a CMS account that allows you to view a number of reports and important documents related to the PQRS and other CMS programs.  The most important document found in here is your unique Quality & Resource Use Reports- QRUR.  This is the exact link that takes you to register for, and log into the EIDM account:

NOTE: For folks who’ve been doing this for a while, you might recall this was previously referred to as the IACS account.

Availability of the QRUR reports is in the fall, usually around October.  Why are these reports important and what do they mean for you as a provider?   In order to answer this question following is a brief, bulleted PQRS history lesson:

• Many think submitting PQRS measures and following the rules for the measures based on the minimum requirements is enough to avoid penalty.  

• In 2016, if you are a group of 10 or more providers and you submit your required 9 PQRS measures, there is no longer guarantee of penalty avoidance. In the past, this was the case…  but not now.  

• The Value Based Modifier (VBM) determines the successful nature of the submitted measures. In other words, did you and/or your colleagues perform well for the submitted PQRS measures?  If not, penalty may be forthcoming.  The VBM largely determines how your payment adjustment is really calculated, and it is based directly on the PQRS measures you submitted.

When your QRUR report is released it is essentially showing you how your providers “scored” against all other providers, across the nation, in the same/similar specialty.  You are essentially “benchmarked.”  Under the VBM, if you score in the PQRS categories for performance and quality better than others in your specialty, you will see a neutral or upward payment adjustment.  If you score poorly against your peers, a negative payment adjustment may be forthcoming.  

Remember, your payment adjustment is 2 years behind!  Thus, the QRUR reports you will receive now in the fall of 2016 are actually scores based on your 2015 PQRS data, yet they impact your payment adjustment in 2017.  And if that’s not enough to blow your mind, it’s all going to change yet again in just a few months under MIPS. Being nimble and a fast learner is essential for optimal fiscal performance.

While this can be maddening, please, don’t shoot the messenger which is often a PQRS registry or consultant.  It might be helpful for more to understand what the “messenger” (a.k.a., Registry) really is and does, vs. what it does or is not.  

1. Your registry is not responsible for your performance.   Your registry or EMR submits measures the registry clients choose. There are more than 400 PQRS measures and scores of unique QCDR measures but in the end which ones are selected and the clinical performance are the responsibility of the eligible provider, not the registry.  

2. Your registry cannot change the CMS rules. Enough said. 

3. Your registry does not receive your QRUR report unless you send it to them.  Your registry does not conduct benchmarking or “grade” your report cards.  Your registry is simply a repository and ultimately a conduit to CMS.  Making certain the data is in the desired format is the registry’s or EMR’s responsibility. 

4. Your registry or EMR vendor may help you understand current PQRS policies and how to follow the CMS rules and policies. However, the ultimate responsibility remains with the eligible provider and his/her practice. 

Think of your registry as a friendly, helpful translator in an unknown and very foreign country!  They will help you understand the cultural terrain of that country, translate what the people are saying, and convey what they want you to do. However, once you have that information, they can’t control what you do with it, how you act, or your response.   

So, the final “translation” points to help eligible providers:

1. QRUR are important and coming out soon (Fall is when they are delivered.)  

2. Share the info with your registry or EMR vendor.

3. Read your QRUR and contact your registry if you don’t understand it. 

Each eligible provider should know performance and quality results are based on how you compared nationally against others nationwide.  If you submitted PQRS data with a lot of “performance not met” answers, expect some negative financial adjustments under the VBM.  

If you have not already selected measures, do so now. Thereafter, capture data in 2016 with good quality and performance.   As often as able, pick measures where you can answer “performance met” and make certain documentation substantiates submitted data. Providers have control over their destiny but only if they are proactive in learning and responding to the morphing landscape around value based compensation.