MIPS Quality Measure Specifications 2019 in a Nutshell

By the term ‘Measure Specification’, means the detailed description of a measure. Therefore, 2019 MIPS Quality measure specifications are the detailed guidelines of quality measures intended to be used by individuals MIPS eligible clinicians reporting CQMs via Qualified Clinical Data Registry (QCDR) or Qualified Registry and by groups reporting via Qualified Registry for the QPP 2019.

To make things simpler, each measure specification has a measured flow and related algorithm as additional help for data completeness and performance. However, a measure specification should be considered final descriptive information on measures because measure flows may or may not be attested by the Measure Steward.

A Brief Recap

MIPS by CMS is an evaluation system by which eligible clinicians can submit their performance with the government to stay compliant and eventually become well-established healthcare professionals. It is a metric to judge the quality of care and their performance via the submission of certain measures or measure sets.

MIPS 2018 was the successful application of performance analysis for many clinicians which brings us to MIPS 2019 and what it has in the box for them. Measures are not difficult to finalize, but an understanding of the measure’s specifications helps each participant what exactly they are about to submit. Measure specifications also highlight their key aspects, the number of times they are to be reported, respective codes, and more.

ECs must report at least 6 MIPS quality measures in 2019 including at least 1 outcome measure or a high priority measure, or to report on a complete measure specialty or sub-specialty set.

What is New in 2019?

The government has come up with an improved criterion for 2019 to measure the performance of clinicians giving them freedom in the following ways:

CMS adds opioid-related quality measures to the set of high priority measures.
In 2019, you get more options in terms of submitting the same measure through different collection types (that include QCDR, MIPS CQMs, CMS Web Interface, and Medicare Part B Claims Measures) to optimize your score for that measure.
You can choose measures from different collection types available to you to find the most meaningful measures for your practice.

Understanding 2019 MIPS Quality Measure Specifications

Clinical Quality measures specifications encompass the guidelines to follow during the submission of CMS MIPS quality measures. Each measure is distinguished by a unique identifier. These are the numbers that represent continuity from measures in the 2018 QPP.

Furthermore, Measure Stewards have decided on these measures by applying some changes to the list of MIPS quality measures in the previous performance year.

Frequency of a Measure

Frequency labels are part of each measure’s execution plan as well as part of the measured flow. The analytical submitting frequency suggests the time frame for which a measure needs to be submitted. Each eligible clinician participating in MIPS 2019 has to submit measures according to their given frequency. The definitions adhered to under the frequency label concerning 2019 MIPS Quality measure specifications are mentioned below:

Patient-Intermediate measures follow submissions minimum once per patient during the performance year. The most current quality codes should be utilized in case the measure needs submission more than once.
Patient-Process measures submissions happen once per patient at the minimum during the performance year. The most rewarding quality-data code is used if the measure undergoes submissions more than once.
Patient-Periodic measures undergo submissions once per patient at the minimum during the performance year. If it is submitted more than once, use the most rewarding quality-data code. If two or more quality codes are submitted, performance shall be evaluated through the most rewarding quality-data code.
Episode-based measures are submitted once per occurrence of an illness or condition during the performance year.
Procedure-based measures undergo submissions each time a procedure occurs during the performance year.
Visit-based measures go through submissions every time a patient visits the MIPS eligible clinician in their clinic or hospital during the performance period.

Performance Period

The performance period for a measure may refer to the time duration from January 1 to December 31. There are many sections to a measure specification like Instruction, Description, or Numerator Statement that may hold the details on the performance period.

Denominator and Numerator

Quality measures consist of a numerator and denominator that are used to evaluate data completeness which forms the final score of the MIPS eligible clinician.

As a MIPS Qualified Registry, P3 Healthcare Solutions, Ontario, CA works on behalf of clinicians to help them achieve scores above 75. Such high scores in 2019 can pave the way towards a future in which there is fame, respect, and ultimately high income.

Do you think the QPP program correlates with the demands of the healthcare sector?