Form CMS-10805 Submissions Experience Survey

QPP Submissions Experience Survey

Survey Guide

Note - no user will encounter all of these questions. This survey is written to account for all the possible ways someone might submit data to QPP in a given performance year. They might use a Registry, Web Interface, or the SFUI but not all three. Expected burden: 10 minutes.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1399 (Expiration date: 08/31/2024). The time required to complete this information collection is estimated to average 0.25 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact QPP at [email protected] 

Screener (All Users)
Q1. Years of Reporting experience [multi select]	What performance years (PY) have you submitted data for (in any way). Select all that apply. PY 2022 will be my first year I submit data to QPP In PY2021 I submitted data [MUST SELECT] PY2020 PY2019 PY2018 PY2017 I have not personally submitted data
Q2. Submission Method - Registry [Single select]	Are you a Registry or QCDR vendor who submitted data for PY2021? Select which best applies. I personally submitted data via the Submissions API [Skip to Registry section] I personally uploaded data via the Registry Dashboard [Skip to Registry section] I submit via the Submissions API and Registry Dashboard [Skip to Registry section] None of the above
Q3. Submission Method - Work with a Registry [Single select]	For PY2021, did you personally work with a Qualified Registry or QCDR to collect data? Yes, I worked with a QCDR [Display Registry questions] Yes, I worked with a Qualified Registry (QR) [Display Registry questions] No, I didn’t work with either I’m not sure
Q4. Submission Method - Work with a Registry [Single select]	For PY2021, did a Qualified Registry or QCDR submit Quality data on your organization's behalf? Yes, a QCDR submitted on my behalf [Display Registry questions] Yes, a Qualified Registry (QR) submitted on my behalf [Display Registry questions] No, neither submitted data for me I’m not sure
Q5. Submission Method Show only if selected PY2021 for Q1. [Single select]	Who did you personally submit data for PY2021? (Please answer for just PY2021). Select which best fits your situation. On behalf of an individual(s). On behalf of a Virtual Group. On behalf of a group/TIN(s). I personally did not submit the data; I shadowed those who did. I was not personally involved in data submissions for PY2021 None of the above.
NOTE to survey programmer: users will be screened out unless ONE of the following is true: Must be a Registry/QCDR vendor (Q2) Must work with a Registry / QCDR (Q3 or Q4) Must personally submit data to QPP for PY2021 (individual, group, and/or virtual group) (Q5)
Screener: Web Interface and QPP Portal Users
Q6. Reporting Pathway [Multi-select]	Which pathway did you submit data for? Select all that apply. Traditional MIPS APP (APM Performance Pathway) I don’t know [mark exclusive] [Screen Out]
Q7. Submission Reporting Pathway > APP Show if selected Reports APP [Multi select]	For the APP, what categories did you personally submit data and/or do a manual entry for? Select all that apply. Quality [Display Q8] Promoting Interoberpabiliy (PI) I’m not sure [mark exclusive]
Q8. Submission Reporting Pathway > APP > Quality Measures Show only if selected Quality for APP [Single select]	Thinking of submitting Quality measures for the APP for PY2021, which best describes you? I personally submitted CMS Web Interface Measures [Display WI questions] I personally uploaded a file of CQMS, eCQMs, and/or QCDR measures [Display QPP Portal Question] None of the above [Skip APP Quality questions]
Q9. Submission Reporting Pathway > Traditional MIPS Show if selected Reports Traditional MIPS. [Multi select]	For Traditional MIPS, what categories did you personally submit data and/or do a manual entry for? Select all that apply. Quality [Display Q10] Promoting Interoperability (PI) Improvement Activities (IA) I’m not sure [mark exclusive] [screen out]
Q10. Submission Reporting Pathway > Trad. MIPS > Quality Measures Show only if selected Quality for Trad. MIPS	Thinking of submitting Quality measures for Traditional MIPS for PY2021, which best describes you? I personally submitted CMS Web Interface Measures [Display WI questions - Trad. MIPS] I personally uploaded a file (e.g. CQMS, eCQMs and/or QCDR measures) [Show QPP Portal Question - Trad MIPS] None of the above [skip Quality questions]
Q11. How data is submitted [Single Select]	Generally, how did you typically submit data? I typically submit all data for a TIN or NPI at once I typically submit only some data in one sitting, so I visit the same record multiple times to add more data. A combination of both Other (__)
Submissions Experience (Web Interface) Note to survey programmer: DISPLAY the Web Interface block ONLY if selected Reporting Pathway > Measures > Quality Measures = CMS Web Interface (APP OR Trad MIPS)
Q12. Submissions Experience - Full Experience [Maxtrix; randomize order of responses]	Take a moment to think about your experience using the QPP website to submit CMS Web Interface measures for PY2021. Use the rating to select how you disagree or agree with each of the following statements. (1=Strongly Disagree . . . 5= Strongly agree) The QPP website is easy to use It is easy to navigate within the QPP website The information on the QPP website is credible The information on the QPP website is trustworthy I find the QPP website to be attractive The QPP website has a clean and simple presentation 1= Strongly Disagree 2 3 4 5 = Strongly Agree
Q13. Web Interface - Clarity [Likert]	Rate how difficult or easy it was to submit CMS Web Interface measures for PY2021 1= Very difficult 2 3 4 5 = Very Easy Thinking of the information (content, messaging) you encountered when submitting the CMS Web Interface measures. . . How unclear or clear was that information? 1=Not at all clear 2 3 4 5 = Very Clear
Q14. Preliminary score and Submission time [Likert]	Rate how you disagree or agree with the following statement. (1=Strongly Disagree . . . 5= Strongly agree) It took me a reasonable amount of time to complete submitting data. 1= Strongly Disagree 2 3 4 5 = Strongly Agree
Q15. Submissions Received - Confidence [Likert]	How confident are you that CMS/QPP accurately received all the data you submitted? 1 = Not at all confident 2 3 4 5 = Very Confident
Q16. PY Comparison Show if selected Submission Method > Log-in for Web Interface and user reported data for PY2020 and P2021 [Likert]	How does your submissions experience for PY2021 compare to the submissions for PY2020? 1 - PY2021 was much worse than PY2020 2 - PY2021 was a little worse 3 - neutral 4 - PY2021 was a little better 5 - PY2021 was much better than PY2020 X I did not submit data via Web Interface in PY2020 [mark exclusive]
Q17. Web Interface - Open End [Open ended] Optional	If you could change anything about submitting Web Interface measures that would improve your experience, what would you change?
Submissions Experience (QPP Portal)
Q18. Submissions Experience - Full Experience for QPP Portal [Maxtrix; randomize order of responses]	Take a moment to think about your experience uploading and/or attesting to data for PY2021. Use the rating to select how you disagree or agree with each of the following statements. (1=Strongly Disagree . . . 5= Strongly agree) The QPP website is easy to use It is easy to navigate within the QPP website The information on the QPP website is credible The information on the QPP website is trustworthy I find the QPP website to be attractive The QPP website has a clean and simple presentation 1= Strongly Disagree 2 3 4 5 = Strongly Agree
Q19. Submission - Quality Show if Submission Method is Quality, not Web Interface (Q8 or Q10) [Likert]	Rate how difficult or easy it was to prepare the files for Quality data to submit to QPP for PY2021. 1= Very difficult 2 3 4 5 = Very Easy Rate how difficult or easy it was to submit/upload Quality data to QPP for PY2021. 1= Very difficult 2 3 4 5 = Very Easy Rate how unclear or clear the content, messaging, and information was in the QPP Portal for uploading Quality data. 1= Not at all clear 2 3 4 5 = Very Clear
Q20. Submission - PI Show if Submission Method is PI [Multi-select] [Likert]	How did you submit PI data? [select all that apply] Upload a file Manual entry/attestation [Display if selected upload a file] Rate how difficult or easy it was to prepare the files of PI data to submit to QPP for PY2021. 1= Very difficult 2 3 4 5 = Very Easy Rate how difficult or easy it was to submit/attest to PI for PY2021. 1= Very difficult 2 3 4 5 = Very Easy Rate how unclear or clear the content, messaging, and information was in the QPP Portal for submit/attest to PI. 1=Not at all clear 2 3 4 5 = Very Clear
Q21. Submission - IA Show only if Submission Method is IA - Traditional MIPS (Q9) [Multi-select] [Likert]	How did you submit for Improvement Activities (IA) [select all that apply] Upload a file Manual entry/attestation [Display if selected upload a file] Rate how difficult or easy it was to prepare the files of IA data to submit to QPP for PY2021 1= Very difficult 2 3 4 5 = Very Easy Rate how difficult or easy it was to submit/attest to IA for PY2021. 1= Very difficult 2 3 4 5 = Very Easy Rate how unclear or clear the content, messaging, and information was in the QPP Portal for submitting/attesting to IA. 1=Not at all clear 2 3 4 5 = Very Clear
Q22. Preliminary score and Submission time [Likert]	Use the rating to select how you disagree or agree with each of the following statements. (1=Strongly Disagree . . . 5= Strongly agree) The preliminary scores matched my expectations based on the data I submitted. It took me a reasonable amount of time to complete submitting data. 1= Strongly Disagree 2 3 4 5 = Strongly Agree
Q23. Submissions Received - Confidence [Likert]	How confident are you that CMS/QPP accurately received all the data you submitted? 1 = Not at all confident 2 3 4 5 = Very Confident
Q24. PY Comparison Show if user reported data for PY2020 and P2021 [Likert]	How does your submissions experience for PY2021 compare to the submissions for PY2020? 1 - PY2021 was much worse than PY2020 2 - PY2021 was a little worse 3 - neutral 4 - PY2021 was a little better 5 - PY2021 was much better than PY2020 X I did not submit data in the QPP portal for PY2020 [mark exclusive]
Q25. Issues [Multi-Select]	During your submissions experience for PY2021, what, if any, of the following did you encounter? Select all that apply. How a score was calculated did not make sense to me (e.g. Quality, Preliminary score, etc) How bonus points were calculated did not make sense Issue logging into the QPP portal Issue/confusion with exceptions Issue or confusion with how Special Status impacts my score I got an error when attesting/uploading/submitting data I had an issue uploading Quality data (that was not an error) [Display only if submits Quality] I had an issue attesting to PI, other than an error message [Display only if attested to PI] I had an issue with attesting to IA, other than an error message [Display only if attested to IA] A file(s) I submitted was rejected Data had already been submitted that I was not expecting I had to contact the Help Desk about my submission. Confusion moving between the different pages for IA, PI, and /or Quality Other (___) I didn’t encounter any issues [mark exclusive].
Q26. Impact of the issue Display only issues that were selected in the previous question. [Likert]	Rate the impact of these issues on your experiencing reporting data to QPP for PY2021. 1. No impact 2. Slight impact 3. Moderate impact 4. Strong impact 5. Very strong impact
Q27. QPP Portal Open End [Open ended] Optional	If you could change anything about submitting data to QPP (for Quality, PI, and/or IA) that would improve your experience, what would you change?
Submissions Experience (as a Registry) Note to Survey Programmer: Display Block only if User reports as Registry (Q2)
Q.28 Reporting Pathway - Registry API and Dashboard [Multi-select]	Which pathway did you submit data for? [Select all that apply]. Traditional MIPS APP (APM Performance Pathway) I don’t know [mark exclusive]
Q29. Registry - API Show if Submission Method -Registry is API [Likert]	Rate how difficult or easy it was to submit data via the API for PY2021 1= Very difficult 2 3 4 5 = Strongly Easy
Q30. Registry Dashboard Show if Submission Method is Registry Dashboard [Maxtrix]	Take a moment to think about your experience submitting data using the Registry Dashboard for PY2021. Use the rating to select how you disagree or agree with each of the following statements as it relates to the Registry Dashboard (1=Strongly Disagree . . . 5= Strongly agree). The Registry Dashboard was easy to use It is easy to navigate within the Registry Dashboard The information on the Registry Dashboard is credible The information on the Registry Dashboard is trustworthy I find the Registry Dashboard to be attractive TheRegistry Dashboard has a clean and simple presentation 1= Strongly Disagree 2 3 4 5 = Strongly Agree
Q31. Registry - Dashboard Show if Submission Method is Registry Dashboard [Likert]	Rate how unclear or clear the content, messaging, and information was for submitting data using the Registry Dashboard. 1=Not at all clear 2 3 4 5 = Very Clear
Q32. Registry - Dashboard - Time Show if Submission Method is Registry Dashboard Dashboard OR API [Likert]	It took me a reasonable amount of time to complete submitting data. 1= Strongly Disagree 2 3 4 5 = Strongly Agree
Q33. Submissions Received - Confidence Show if Submission Method is Registry Dashboard OR API [Likert]	How confident are you that CMS/QPP accurately received all the data you submitted? 1 = Not at all confident 2 3 4 5=Very Confident
Q34. PY Comparison Show if Submission Method is Registry Dashboard OR API Show if user reported data for PY2020 and P2021 [Likert]	How does your submissions experience for PY2021 compare to the submissions for PY2020? 1 - PY2021 was much worse than PY2020 2 - PY2021 was a little worse 3 - neutral 4 - PY2021 was a little better 5 - PY2021 was much better than PY2020
Q35. Registry - Suggestion for Improvement Show if Submission Method is Registry (API or Dashboard) [Open ended] Optional	As a Registry/QCDR, what suggestions do you have to improve your experience submitting data to QPP?
Submissions Experience - Used a Registry Note to Survey Programmer: Display Block only if User worked with Registry (Q3 or Q4)
Q36. Registry - Used a Registry Show if used a Registry (Q3 or Q4) [Likert]	Rate how difficult or easy was it to work with a Qualified Registry/QCDR to report data to QPP for PY2021? 1= Very difficult 2 3 4 5 = Strongly Easy Rate the likelihood of working with the same QR/QCDR in the future 1 = Not at all likely. . . 5 = Very likely
Q37. Registry - Used a Registry Show if Submission Method is Registry submitted on my behalf - (Q4 only) [Likert]	How confident are you in the accuracy of the data the QR /QCDR submitted to QPP? 1= Not at all confident 2 3 4 5 = Very confident
Q38. Registry - Used a Registry Show if used a Registry (Q3 or Q4) [Open ended] Optional	In a sentence or two, could you share why you chose to work with a Qualified Registry or QCDR vendor?
Q39. Registry - Used a Registry Show if used a Registry (Q3 or Q4) [Open ended] Optional	What suggestions do you have for QPP that would improve your experience using a QR / QCDR to submit data?
Program Follow-Ups (ALL USERS)
Q40. Program requirements - Trad. MIPS Show only if Pathway is Trad. MIPS (Q6) [Likert]	Thinking ahead, rate your level of confidence with understanding the program requirements for reporting Traditional MIPS for PY2022. 1 = Not at all confident 2 3 4 5 = Very confident
Q41. Program requirements - APP Show only if Pathway is APP (Q6) [Likert]	Thinking ahead, rate your level of confidence with understanding the program requirements for APP (APM Performance Pathway) for PY2022. 1 = Not at all confident 2 3 4 5 = Very confident
Q42. Suggestion for Improvement Show if Pathway is Traditional MIPS (Q6) [Open ended] Optional	If you could change anything to improve your experience submitting data for Traditional MIPS, what would you change?
Q43. Suggestion for Improvement - APP Show if Pathway is APP (Q6) [Open ended] Optional	If you could change anything to improve your experience submitting data for the APP, what would you change?
Demographic Follow-Ups
Q44. Size of Org (no. of NPIs reporting for) [Single Select]	About how many clinicians/providers total participate in QPP through your organization. 1-5 providers 6-15 16-24 25 - 49 50 -99 100 - 999 1,000 - 4,999 5,000 or more
Q45. No. of TINS reporting for [Single Select]	About how many individuals/TINS participate in QPP through your organization? 1 TIN 2-15 16 - 24 25-49 50 -99 100 or more TINs
Q46. Participation in QPP [Select all that apply]	How did you/your participants take part in the Quality Payment Program for PY2021? [Select all that apply] Traditional MIPS MIPS APM APM Advanced APM
Q47. APM Model [Show if MIPS APM. APM, Advanced APM is selected]	What APM model do you participate in? CPC+ Medicare Shared Savings Program (MSSP) Primary Care First (PCF) Other ___
Q48. Organization [Single select]	What type of organization do you work for? Primary Care Specialty Multi-Specialty CAH Hospital Healthcare System ACO QCDR/Qualified Registry Professional Society EHR / EMR IT vendor Other [___]
Q49. Duties in the Org [Multi select]	Which of the following duties do you perform when it comes to the Quality Payment Program? Select all that apply. I manage the team that does the reporting I track down missing patient records I train staff and/or clinicians on the Quality Payment Program (e.g. on reporting, data collection, etc). I choose what measures to report I audit/troubleshoot data in my organization’s EHR/EMR I abstract data for submission I enter and/or upload the data in QPP for reporting I serve as my team’s point of contact for CMS / QPP Other [___]

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