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MIPS Quality Measures 2020, MIPS incentives, MIPS Quality measures, MIPS data submission, MIPS quality reporting, submit mips data, MIPS registry, healthcare Solutions, MIPS 2020, MIPS consulting firm, MIPS consultant, MIPS data via clinical quality measures, MIPS solutions, MIPS CQM

MIPS Quality Measures 2020 and Specifications for MDs and DOs

Am I eligible for MIPS incentives in 2022?

The question that we hear a lot. And, I have to say it is your right to know.

Whether you are a general physician or a surgeon, submission of MIPS Quality measures leads the way to incentives.

Why?

The government started MIPS back in 2017 to incentivize eligible clinicians, and in return, improve the quality of healthcare. In short, it ensures ECs submit measures for the good of their patients – they will have permanent access to quality care.

The purpose here is to write down a MIPS Quality measures list that includes at least some measures and leave the rest to update in the future. Therefore, you’ll see some of them if not all; we’ll keep updating it, hopefully.

I also hope to provide info not only for family and general physicians but for specialists too. In an ideal system, the MDs, and DOs work in rhythmic harmony for better care coordination and patient experience.

Difference between an MD and a DO

For those of us who don’t know what an MD is, it is short for Medical Doctor, while DO stands for Doctor of Osteopathic Medicine.

Although they may use all the available methods to treat their patients, including drugs and surgery, DOs believe in a more holistic approach. By definition, DOs emphasize preventive medicine, musculoskeletal health, and holistic care. It doesn’t mean MDs are any less skilled or vice versa. Both are equally capable.

The Expertise of Both Specialists

Both specialists, MDs and DOs, can choose to practice in any specialty. Both lend their expertise to promote the quality of healthcare to patients translating CMS MIPS quality measures.

AMA (American Medical Association) studied that in 2018, up to 57% of more DOs preferred to practice in primary care compared to 32% of the MDs.

The total statistics for DOs participation in primary care were:

  • 9% went for family physicians
  • 8% went for internists
  • 8% went for pediatricians

However, both programs offer a license, thus, it does not matter what program a student pursues.

Define the Quality Performance Category

One of the categories of the Merit-based Incentive Payment System (MIPS) is the Quality performance category! It holds a 45% weight in the total score.

What does it account for?

It measures your performance in clinical activities and patient outcomes. MIPS data submission through Quality measures helps assess health care processes, manage results, and patient experiences. As a result, we can expect the highest quality of care while keeping expenses to a minimum. Hence, the achievement of the value-based care purpose.

Understanding CMS MIPS Quality Measures

  1. Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 

Diabetes, a menace, to say the least, shadows quite a part of the US population. How can we put a lid on it? Well, the answer lies in value-based care. More importantly, it is MIPS quality reporting that will eventually decrease the number of diabetics across the country.

This particular measure says to submit data on your patients from the age of 18-75 with diabetes who had hemoglobin A1c > 9.0% during the measurement period.

A CMS eCQM is available for this outcome measure. The collection types for this measure include:

  • Medicare Part B Claims
  • eCQM (electronic-clinical quality measure)
  • CMS Web Interface
  • MIPS CQM (clinical quality measure)

Since one of the collection types of this measure is MIPS CQM, you can submit it through a registry. It is one of the most effective of all the MIPS data submission methods thus far.

You can submit it if you are part of the following areas, provided you fulfill the low-volume threshold for MIPS:

    • Family medicine
    • Internal medicine
    • Preventive medicine
    • Nephrology
    • Endocrinology
    • Nutrition/dietician
  1. Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)

Measure number 2 is related to the heart. American Academy of Cardiologists

It includes people aged 18 and above who were diagnosed with heart failure (HF) with a present or past left ventricular ejection fraction (LVEF) < 40% and were prescribed beta-blocker therapy either within a year of procedure in an outpatient setting or at each hospital discharge.

Reporting MIPS through this measure sets the tone for the management of chronic conditions. Gladly, it is available in both eCQM and CQM type, thus acceptable through various sources.

Specialties for which this measure is suitable to include:

  • Cardiology
  • Family medicine
  • Internal medicine
  • Hospitalists
  • Skilled nursing facility
  1. Anti-Depressant Medication Management

Psychiatrists act as pillars of healthcare when it comes to mental health treatment. Especially, their role is critical through the COVID-19 pandemic. Could there be a worse time for mental health issues to rise? Well, it could be worse!

Being grateful and using empathy as a tool to interact with people around us is needed for sure. The description of this measure that we have with us is mostly for eligible psychiatrists. MIPS 2020 presents numerous measures to report with accuracy and data integrity as the two requirements.

It is quality measure #9, according to the official fact sheet released by CMS.

How do we describe it?

It aims to find a percentage of people aged 18 years and above who were treated for mental illness and prescribed antidepressants. As per their depression symptoms, they have prescribed medication for months. You should report the following two types:

  1. First, the percentage of patients who were on antidepressants for at least 84 days (12 weeks)
  2. Second, the percentage of patients who were on antidepressants for at least 180 days (6 months)

Why is this measure meaningful?

It is in line with the prevention and treatment of opioid and substance use disorders. A MIPS consulting firm helps you select the right measures to report. More importantly, it is the accuracy and data completeness that matters to maximize MIPS incentives.

The collection type available for this measure is eCQM. Moreover, the specialties that this measure services include:

  • Family medicine
  • Internal medicine
  • Mental/behavioral health
  1. Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Eyes let us see the beauty around us, thankfully. They show us the world as it is. In this quality measure, people aged 50 years and above are to participate. As an EC, you are to report it once they are diagnosed with age-related macular degeneration (AMD), followed by a dilated macular examination.

Further, it led to the recording of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the intensity of the damage caused during one or more office visits within the 12-month assessment period.

Henceforth, this measure assesses the chronic conditions management area. Ophthalmologists are to report it through their MIPS consultant. MIPS solutions and to send MIPS data via clinical quality measures type is doable with plenty of support from qualified registries.

The collection type for this measure includes:

  • Medicare Part B Claims
  • MIPS CQM

In fact, it is only available for the ophthalmology specialty.

  1. Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

As the title clearly says, the measure goes against the menace of diabetes and its effect on the eyes. Value-based care becomes viable to bring back quality into healthcare, and at the same time dial-down, healthcare costs.

The measure specifications for clinicians help in its understanding. Our research concluded this measure to be part of the MIPS Quality measures list released officially by CMS.

Essentially, MIPS 2020 covers the continuing process of our healthcare, moving in the right direction. Let us see what the measure means:

“Percentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 months.”

Willing to go after MIPS data submission for this measure? It is most likely to score high if reported accurately. That is where P3 comes in to report to CMS on your behalf. The basics of this measure put it amongst the CQMs and eCQMs. Moreover, it is a high priority measure applicable to the ophthalmology specialty.

  1. Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older

It is a measure that directly informs of the health of our seniors as far as their fractures and overall health is concerned. The meaningful area under discussion here is the Health Information Exchange (HIE) and Promoting Interoperability.

What does the measure exactly mean?

According to CMS, it derives the following explanation:

“Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient’s on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing.”

It is submitted by the physician who treats the fracture and who therefore is held accountable for the communication. A high priority measure, to begin with, you can use Medicare Part B Claims and MIPS CQMs as its collection types.

As an EC, if you are part of the following specialties, you can choose to report this measure.
• Family medicine
• Internal medicine
• Orthopedic surgery
• Preventive medicine
• Rheumatology

  1.   Advance Care Plan

The Advance Care Plan deals with many branches of healthcare, including Cardiology, Family Medicine, Gastroenterology, General Surgery, Neurology, Obstetrics/Gynecology, and more.

How Do We Describe this MIPS Quality Measure?

MIPS in healthcare defines this measure by the percentage of the patients aged 65 years or older with an Advance Care Plan. This measure is also valid for those patients who document another decision-maker on their behalf as a surrogate on authentic medical records.

Another situation is when the medical records show that the Advance Care Plan was discussed with the patient, but they could not provide a surrogate neither they wished to.

MIPS 2020 Reporting Instruction for Advance Care Plan

MIPS eligible clinicians can submit this quality measure for just one patient seen throughout the performance period. There is no specific diagnosis attached to this MIPS Quality Measure. However, the MIPS Qualified Registry on behalf of physicians can submit data for the quality services provided to the patient based on the measure-specific denominator coding.

It is to note that that this measure applies to all healthcare settings, be it nursing home, etc., except for emergencies.

Measure Submission Type

Individual clinicians, groups, and third-party intermediaries such as a MIPS Qualified Registry submit the related data to CMS. However, only those third-party intermediaries can submit data, which used Medicare Part B claims.

Conclusion

Thus, paying special attention to the MIPS quality measures can maximize the chance to earn positive adjustments and even incentives.

It all depends on the CMS MIPS quality measures that you submit to CMS. Therefore, MDs and DOs, take time to strategize MIPS solutions properly and improve your financial situation.

How Can MIPS Consulting Services Help Increase Your CPS?

MIPS has been an amazing initiative in the healthcare industry. This quality payment program instantly got attention from clinicians in terms of providing value-based services to patients. Therefore, the physicians’ participation rate has been outstanding since the very first year. This trend has also put pressure on the MIPS consulting services to use improved methods to better report clinical data.

Another reason for high participation is the fortification from the penalty that is imposed on non-participation or poor performance. This has to do a lot in changing physicians’ thinking to strive for being the top-scorer, especially, when there is so much to gain as incentives and bonuses.

Reporting MIPS quality measures with data completeness constraint requires accuracy and dedication from MIPS consulting services. The thing to consider is that healthcare organizations already have data and then consult MIPS qualified registries to report data.

Then, how can MIPS consulting services improve performance based on the present data? This question demands thorough analysis and this article gives insight into four MIPS score-increasing tactics.

  • Document Data for a Large Set of Quality Measures & Look for High Performers

This is the simplest way to ensure that the data you have is best for reporting MIPS quality measures. When healthcare organizations consult MIPS consulting services, most of them already know about the best-suited quality measures. However, there are some that at the start of the MIPS reporting period, run hundreds of tests to determine the most scoring MIPS quality measures.

The advantage of running this strategy besides the obvious one is to check if you can get extra points from the available data while submitting it to CMS. Moreover, the search for high-priority measures becomes easy for MIPS consulting services via this method.

Some professionally qualified registries or even healthcare organizations tend to chase a larger set of performance measures throughout the year. This way, they get the flexibility to report for the best performing measures at the end of the year.

  • Switch to Electronic Methods for Reporting

The end-to-end electronic reporting method is the best way to earn bonus points, and thus requires data submission through Certified Electronic Health Record Technology (CEHRT) to CMS. It automates the data submission process with efficient data extraction and measures calculation.

This method helps MIPS consulting agencies to earn additional points per measure or even increase 10% of the total MIPS score.

  • MIPS Consulting Services Should Report Free Text DataMIPS Consulting and quality measures

Qualified services should invest additional efforts in collecting free-text data. It surely involves the extra time and a bit of investment but can result in improving the MIPS scorecard.

Going through patients’ reviews and medical codes can help taking out important points. A dedicated team is required to abstract data for this purpose. Otherwise, outsourcing companies can also do this favor for MIPS consulting services.

  • Review the MIPS Score for Individual & Group Performance

Getting incentives and eligibility for the bonus pool gear up physicians’ performance and it is only possible when MIPS data is optimized. Before data submission, reporting services should check performance rates both as individuals and even as a group.

It is possible that clinicians get more points while submitting data as a group for treating a similar set of patients. It also helps to add low-performing physicians in the group that may be excluded from the MIPS race as individual healthcare providers.

Thus, physicians can earn a high score when MIPS consulting services uses a few simple tricks. Indeed, these tricks require efforts and but continuous monitoring of score throughout the year, provide opportunities to increase revenue cycle.

As a MIPS consulting service, would you try these tactics or have any other ideas for high MIPS score, share with us at https://www.linkedin.com/company/p3-healthcare-solutions

MIPS 2018 Updates For Clinicians And Healthcare Providers

The MIPS 2018 will help the healthcare providers realign themselves to ensure compliance, enabling them to keep taking advantage of the incentive payments.

CMS gave an update on 2nd November 2017, sharing MIPS 2018 updates applicable to the QPP (Quality Payment Program).

A Background to the MIPS 2018 Updates

We all know that there is a shift in the US healthcare industry towards quality healthcare. These new updates reflect the refinement of the policies for QPP while taking into consideration the US healthcare industry’s transformation concerning infrastructure, technology, clinical practices, and physician support practices.

MIPS 2018 Updates & QPP Strategic Payment Program Objectives

CMS aims to accomplish 7 strategic QPP objectives with the introduction of MIPS 2018 Updates.

  1. To assist in the overall improvement of beneficiary outcomes. It also means engaging patients by deploying relevant MIPS and Advanced APM policies.
  2. The improvement in the clinician experience through the introduction of a transparent and flexible program. This approach will help provide clinicians with easy to use program tools.
  3. Increase adoption and availability of the robust Advanced APMs.
  4. Maximize participation and understanding of the program by deploying customized communication that focuses on support, education, and outreach. The underlying theme is to ensure the program fulfills the needs of diverse types of practices, patients, physicians, and small healthcare providers.
  5. To promote the increased sharing of data and information relating to the program’s performance. Thus, the underlying concept is ensuring timely yet accurate availability of actionable feedback to clinicians and other relevant stakeholders.
  6. Help deliver IT systems with improved capabilities relating to reporting, data submission, and an overall improvement in its front and backend, delivering greater efficiency and value.
  7. Lastly, one of the core strategic QQP objectives is to improve program implementation and foster ongoing development that keeps the requirements of the US healthcare industry into context. Furthermore, it also helps small and rural healthcare providers successfully take part in the program.

What are the MIPS 2018 Updates?

MIPS 2018 Updates and quality measures

Let’s look at the highlights of MIPS 2018 updates.

  • Performance Period
  • The performance period is changed from 90 days to the 12-month calendar year.
  • The cost will be applicable based on the 12-month calendar year.
  • A minimum of 90 days period will be under review for Advancing Care Information.
  • A minimum of 90 days period will be under consideration for evaluating Improvement Activities.

Performance Threshold or Payment Adjustment

  • Minimum Performance Threshold will consider 15 instead of 3 points.

Road to accomplishing 15 points for performance threshold

Here is how you can attempt to accomplish the 15 points. You can fulfill any one of these criteria to reach the goal of 15 points.

  • To submit 6 Quality Measures that meet data completeness criteria.
  • To meet the base score for Advancing Care Information. To accomplish it, you will have to submit 5 base measures and also submit a medium-weighted Improvement Activity.
  • To meet the base score for Advancing Care Information. Also, submit 1 Quality Measure which meets data completeness requirements.
  • Lastly, you can also reach the 15-points performance threshold goal by reporting all Improvement Activities.
  • For achieving exceptional performance, the providers must reach the threshold of 70 points.
  • The law requires the payment adjustment for the 2020 payment year to range between -5% to +5X% (where +5% means = 5% X scaling factor). The scaling factor is achieved to ensure the accomplishment of budget neutrality.
  • Under the revised MIPS 2018 updates, the adjustment factor applies to items and services under Medicare Part B (It includes Part B drugs too).

Quality

  • The 2018 Quality Measures Specifications will become applicable.
  • Weight to the final score is 50% instead of 60%.
  • For Data Completeness, CMS wants providers and clinicians to meet a minimum threshold of 60% instead of 50%. Therefore, measures not meeting this data completeness criterion will only get 1 instead of 3 points. However, small healthcare practices will still get 3 points.
  • The scoring has a 3-point floor for measures against the benchmark. There are 3 points for measures that either do not have a benchmark or they do not meet the case minimum requirement. Measures which fail to meet data completeness requirements will only get 1 point and not 3 points, except small practices getting 3 points. There is no change introduced for the bonuses. One of the MIPS 2018 updates is that CMS proposes the introduction of a cap of 6 points for a particular set of 6 topped out measures.
  • The improvement scoring will be given by measuring the rate of improvement. The increase in improvement will mean more points, particularly for the providers that have a lower performance during the transition year. The improvement will be measured in the Quality Performance Category Level, with ten percentage points available for Quality Performance Category.
  • One of the MIPS 2018 updates is about the topped out measures scored with a maximum of 7-points and not the standard 10-points.

6 topped out measures for 2018

  • #21. To either select the Prophylactic Antibiotic-First or Second Generation Cephalosporin.
  • #23. Venous Thromboembolism Prophylaxis, when they are indicated in all the patients.
  • #52. COPD (Chronic Obstructive Pulmonary Disease), Inhaled Bronchodilator Therapy.
  • #224. The overutilization of the Imaging Studies in Melanoma.
  • #262. Confirmation via image, of successful excision of Image Localized Breast Lesion.
  • #359. To optimize patient exposure by utilizing Standardized Nomenclature for CT (Computerized Tomography), imaging description.

Improvement Activities

  • The providers must be aware of the specifications of the 2018 Improvement Activities.
  • The weight to the final score will be 15%.
  • There isn’t any change in the number of activities that MIPS eligible clinicians need to report for reaching 40 points. CMS wants to propose more activities to select from and also wants changes to existing activities for Inventory. The clinicians practicing in rural areas and small practices would only be needed to report no more than 1 high-weighted or 2 medium-weighted activities for reaching the highest score.
  • For the TIN to get credit for group participation, only one MIPS eligible clinician would have to perform the Improvement Activity.

Advancing Care Information

  • The providers and clinicians must be aware of the specifications for the 2018 Advancing Care Information Measures.
  • The weight to the final score is 25%.
  • To allow the MIPS eligible clinicians to use either the 2014 or 2015 Edition of CEHRT in 2018. And also to grant them a bonus if they only use the 2015 Edition of CEHRT.
  • To add exclusions for the Health Exchange Measures and E-Prescribing.
  • To add more Improvement Activities which would show the use of CEHRT to the list eligible for a bonus of Advancing Scare Information.
  • One can earn 10% in performance scores if they report about any of the criteria to clinical data registry or single public health agency.
  • An additional 5% is allocated for submitting to one additional clinical data registry or public health agency (not reported underperformance score).
  • To add decertification exception for those eligible clinicians who’s EHR has been decertified, retro effectively for 2017 performance periods.
  • The deadline for exception application submission for the year 2017 and for future years, is set on December 31st for measuring the whole year’s performance.
  • Small practices which have 15 or fewer clinicians, the addition of a new category for hardship exceptions to re-weight the category of Advancing Care Information to 0. To reallocate the 25% of the category weight of Advancing Care Information to the category of Quality Performance.
  • CMS will reweight the category of Advancing Care Information to 0 and reallocate its 25% performance category weight to the category of Quality Performance for these reasons.
  • Automatic Re-weighting
  • Certified registered nurse anesthetists, clinical nurse specialists, physician assistants, and nurse practitioners.
  • The non-patient facing clinicians including pathologists and radiologists.
  • The hospital-based MIPS eligible clinicians.
  • The ASC (Ambulatory Surgical Center) – based MIPS eligible clinicians and the certified registered nurse anesthetists.
  • To reweight through an approved application.
  • There are significant hardship exceptions, and CMS will not be applying a five years limit for these exceptions.
  • A new hardship exception to the clinicians practicing in small practices has 15 or fewer clinicians.
  • There is a new decertification exception added for the eligible clinicians whose EHR has been decertified and becomes effective retroactively for the performance period of 2017.

Cost

  • There will be a weight of 10% added to the final score.
  • CMS will include the total per capita cost measures and MSPB (Medicare Spending per Beneficiary) for calculating the Cost performance category score for the MIPS performance period of 2018. These two measures will be carried over from the Value Modifier Program. These two programs are also currently used for providing feedback for the MIPS transition year.
  • CMS will be calculating the cost measure performance. The clinicians do not need to take any action.
  • The new changes offer Virtual Groups with participation options for Year 2, providing clinicians with another way to participate in MIPS. The Virtual Groups can contain Solo Practitioners and Groups containing 10 or fewer eligible clinicians. They are eligible to participate in MIPS, coming together virtually with at least one such other Solo Practitioner or Group for participating in MIPS. In general, clinicians’ being part of a Virtual Group would have to report as a Virtual Group for four different performance categories. They will also need to meet the same performance category requirements and measures as that of the non-virtual MIPS groups.
  • Virtual Groups need to conduct their elections at the beginning of the performance period. It cannot be changed once the performance period starts.
  • Groups and Solo Practitioners wanting to participate in a Virtual Group have to go through the election process.
  • The period given for election is from October 11thto December 31st, 2017, for them to be considered for the 2018 MIPS performance period.
  • To increase the low volume threshold by excluding individual clinicians or groups eligible for MIPS having < $90,000 in Part B allowed charges. It is also applicable to those individual clinicians or groups with < 200 Part B beneficiaries falling within the low volume threshold determination period occurring during a performance period or a prior period.
  • CMS is not changing the way it defines non-patient facing clinicians. Individuals <100 patient-facing encounters, and for groups, it stands at > 75% NPI’s billing under the group’s TIN falling within a performance period and labeled as non-patient facing.
  • Under the Complex Patients Bonus, there is an adjustment applied to up to 5 bonus points by adding average HCC (Hierarchical Conditions Category) risk score to the final score. The score addition would be anywhere from 1 to 5 points given to the clinicians depending on the patient’s medical complexities.
  • The Small Practice Bonus will adjust the final score of an eligible clinician or group working in a small practice as defined in the regulation, applicable to 15 or fewer clinicians. It would add 5 points to the final score provided eligible clinician or group submits the data for at least one performance category within the applicable performance period.
  • There are payment adjustments by CMS for Extreme and Uncontrollable Circumstances, approximately given to 572,000 eligible clinicians. They would have to participate in MIPS for the 2018 MIPS performance period. Under the newly proposed rule, the payment adjustment for the 2020 payment year may range from =5% to +5X%. (X is the adjustment factor that allows MIPS program for staying budget neutral.)
  • If the CEHRT for an MIPS clinician is unavailable due to uncontrollable circumstances like a natural disaster, public health emergency, or hurricane, etc. the clinician can submit a hardship exception application for getting reconsidered for reweighing of Advancing Care Information performance category. The application is due with a cut-off date of December 31st, 2017.
  • There is a final rule with comment period extending this reweighting policy for the performance categories of Improvement Activities, Cost, and Quality which starts with the 2018 MIPS performance period. The deadline for this hardship exception application is December 31st, 2018.

As far as 2018’s submissions are concerned, the deadline was April 2, 2019. Moving on, if you were eligible back then, you are eligible in 2019 as well.

MIPS consulting services job is to satisfy your end of the deal with the authorities for compliance and data completeness. That is what we do for our clients!

Moreover, those of you who weren’t eligible then may be eligible now. Give us a call or simply fill-up the form on the homepage to notify us. P3 Healthcare Solutions connects clinicians to high scores which means rewards and a better reputation.

QPP 2019 is prevailing and it is important to submit measures against Quality, Meaningful Use (MU) or Promoting Interoperability (PI), Improvement Activities, and Cost performance categories. With the promise of less reporting burden by CMS, we can expect the program to become clinician-friendly as time goes by. Please follow us on LinkedIn here – https://www.linkedin.com/company/p3-healthcare-solutions

What is next?

What changes to expect in MACRA-MIPS 2019?

For questions out of this knowledge base, or on instructions on how to get started call a MIPS specialist today at 1-844-557-3227 (1-844-55-P3CARE) or email at info@www.p3care.com.