Deeper Dive into MIPS – Quality Measures

Digging Deeper into MIPS Quality Measure Requirements

I have frequently heard the idiom “The devil is in the detail” and thought this was such an interesting phrase. After spending the past several weeks leisurely reading the MACRA final rule, I have a new found appreciation of these words. The problem with a legislation this large is there are so many rules and exceptions that have to occur to accommodate the entire healthcare system. It becomes difficult to decipher what is really important to you and your practice.

Over the next few weeks, we will be reviewing these details in a series of blogs and webinars. We will begin by breaking down and understanding each component of the quality measures. If you are needing to take a step back and review the overall financial impact on your business, you can click here to read a previous blog post or watch the video below. This particular post will focus strictly on the Quality component of the MIPS program and the requirements for measures.

In future post, we will discuss more details about the quality measures, the Advancing Care Information and the Improvement Activities.

The Quality Measures are similar to the PQRS measures previously reported but only represent 1 component of MIPS and currently makes up 60% of your total MIPS score. If I were a college student taking a test and a particular portion had a 60% weight, I would be sure to prepare for that section. The question becomes how do you prepare for implementing MIPS into your practice without totally impacting your provider’s performance and satisfaction.

Learning as much as possible about the program and the measures is a good first step. Let’s take a few minutes to explore some key elements delivered to us from CMS. The following list of items was taken directly out of the CMS final ruling of the MACRA program. As I read these items, I felt like this was CMS providing us with a “playbook” of how we should all be participating in this program. We are changing a system and hopefully improving some things along the way.

• Measure performance should be relevant and meaningful
• Maximize the benefits of your CEHRT
• The flexible scoring allows recognition of every clinician’s effort and rewards higher performance for those participating at a higher level
• Measures are designed around real workflows and data that is typically captured through the visit
• Provide scoring that can meaningfully differentiate low and high performers

These statements each have a description and/or meaning that is promoting the improvement of care, ease of implementation and flexibility in the program. We will determine how accurate these thoughts are as we work through the details of the measures and the program in its entirety.

Quality Measure Requirements

How many measures do we have to do?

• Each eligible clinician and group must submit a minimum of 6 measures. One of those measures must be an outcomes measure.
• If an outcomes measure isn’t applicable to the eligible clinician or group, then an additional MIPS Quality Measures high priority measure must be selected.
• There are no cross-cutting measures necessary for 2017
• The measures do NOT have to cross multiple domains as in the previous PQRS program
• We must report on a minimum of 50% of patients regardless of the payer

In order to receive performance points, each measure should represent a minimum of 20 casesLess than 20 cases will get you a minimum score of 3 for that measure if reported to CMS

What if I am a specialist and the measures don’t fit my needs?

• CMS Has Defined “Specialty Sets” for most specialties
• If there are fewer than 6 Measures in your specialty set
  • You only need to report on the measures in your set (outcome measure required)
    • If the measure set for your specialty has less than 6 measures, you do not need to add measures to equal 6 (i.e. Interventional Radiology)
    • The final quality score will be adjusted to accommodate the less than 6 measures

There are several other factors to be considered when selecting the quality measures for your practice. In upcoming posts, we will discuss the scoring system, bonus points available, submission methods and overall strategies for implementing these measures into your practice.

You can find the measures by reviewing the CMS quality page. This page will help you to review the measures and determine which ones will be most beneficial to your practice.