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Home > Healthcare Trends
Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance
Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance
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Under CMS's "Pick Your Pace" choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019 by simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices' performance and laying a path now toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal--Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS).  MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align. 

In this 28-page resource, William Holding, consultant, and Nancy Lane, president, both with PDA, Inc., begin with a high-level look at CMS's QRURs. Subsequently, they drill down to supplemental tables and data that track a practice's quality and cost performance, from patient attribution to physician referral patterns to a longitudinal view of patient expenses. These thought leaders address the following areas:

  • MACRA 101: MIPS, Advanced Alternative Payment Systems (APMs), the fate of the value-based modifier (VBM), and more;
  • Guidelines for physician MACRA preparation;
  • Overcoming the hurdles of CMS Enterprise Portal access;
  • QRUR reports: access, purpose, components and analysis;
  • Four physician practice advantages to utilizing QRUR cost and quality data;
  • A look at seven detailed and downloadable QRUR tables;
  • Summary and drill-down statistics available within the supplemental QRUR tool;
  • Three additional data sources that can help to predict physician practice performance;
  • Using QRURs as part of a five-point game plan for MIPS participation;
and much more, including leveraging QRUR data to select a physician practice's quality measures and compare costs.

Table of Contents

  • Physician MACRA Preparation: Using QRUR and Other CMS Data to Maximize Performance
    • MACRA Overview
    • Merit-Based Incentive Payment System (MIPS)
    • MIPS Versus Value-Based Modifier
    • 5 Prerequisites to Prepare for MACRA
    • Quality Resource and Use Reports (QRUR)
    • QRUR Quality Scores
    • QRUR Cost Scores
    • Additional Downloads: QRUR Tables
    • Supplemental QRUR
    • Benefits of Using QRUR Data
    • Using QRURs to Analyze Medicare Population
    • Other CMS Data Sources
    • Components for MIPS Success
    • Determining Performance Improvement Investment
    • MIPS Implications for Other Payors
    • 5 Considerations for MIPS Participation
  • Q&A: Ask the Experts
    • QRUR Versus QualityNet
    • Updates for QRUR Data
    • Variations in EMRs
    • Assessing Analytics Tools
    • Determining MIPS Competitive Advantage
  • Glossary
  • For More Information
  • About the Contributors
Publication Date: March 2017
Number of Pages: 28
ISBN 10: 1-943542-48-1 (Print version); 1-943542-49-X (PDF version)
ISBN 13: 978-1-943542-48-2 (Print version); 978-1-943542-49-9 (PDF version)
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