Which Quality Measures Should You lot Study?

Here'southward how to select the measures that will maximize your success nether Medicare's new Quality Payment Programme.

Fam Pract Manag. 2017 Jul-Aug;24(4):v-10.

Author disclosure: no relevant financial affiliations disclosed.

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Article Sections

  • Introduction
  • Benchmarks and decile scoring
  • Topped out measures
  • Scoring requirements
  • Bonus points
  • Putting information technology all together

Family physicians in 2022 are in the starting time performance year of the Merit-based Incentive Payment Organization (MIPS), part of a new functioning-based reimbursement plan that volition impact how much they are paid through Medicare in 2022 and beyond.

MIPS is one of ii payment tracks nether the Quality Payment Programme (QPP), which was established when the Medicare Access and Chip Reauthorization Act (MACRA) concluded the sustainable growth rate formula of determining physician payment under Medicare.

By default, physicians volition participate in the MIPS rails unless they choose and qualify to participate in the second payment track as an Avant-garde Alternative Payment Model (APM) or meet several criteria for exclusion from the QPP, such every bit enrolling in Medicare for the kickoff time this year, billing $30,000 or less per year in Medicare Role B charges, or seeing 100 or fewer Medicare Office B patients per yr.

The 2022 reporting period for MIPS ends December. 31. The Centers for Medicare & Medicaid Services (CMS) will not crave physicians to report a full year'southward worth of information in 2017, but they must submit some information to avoid a negative payment adjustment. Physicians should use this transition year to prepare for full participation.

MIPS adjusts physicians' Medicare Part B professional person fee-for-service payments upward or downwards based on how they perform in 4 categories: quality, price, comeback activities, and advancing care information. Each category is scored separately, has its own measures and requirements, and is weighted for its contribution to the terminal score, with quality having the greatest weight at 60 percent. (See "2017 MIPS performance category breakdown.")

2017 MIPS PERFORMANCE CATEGORY BREAKDOWN

Quality: 60 percent

Cost: 0 percent *

Comeback activities: 15 per centum

Advancing intendance information: 25 percentage

*Although the Centers for Medicare & Medicaid Services volition provide feedback on how physicians perform in the cost category based on claims information, information technology will non affect your MIPS score in 2017. This volition change in the future.

The quality category, in general, requires physicians or dr. groups to report data for at least 6 quality measures, including 1 outcomes measure, if reporting using claims, registries, or an electronic health tape (EHR). Note that physicians tin report much less for 2022 depending on how aggressively they plan to comply with MIPS in the outset year. Groups that written report using a web interface (a secure Cyberspace-based data submission option for groups of 25 or more than eligible clinicians) must report data for 15 measures for the full 12 months of 2017. Groups may contract with a survey vendor to report Consumer Cess of Healthcare Providers and Systems (CAHPS) in place of i quality measure. Groups with at to the lowest degree sixteen clinicians and at least 200 cases will also have a readmission population measure calculated for them. (See "Maximum possible points in quality category.")

MAXIMUM POSSIBLE POINTS IN QUALITY CATEGORY

Reporting with claims, registry, Qualified Clinical Data Registry, or EHR:

  • 70 points: Six quality measures and one readmission measure (if applicable)

  • 60 points: Six quality measures (if no readmission measure applies)

Reporting with CMS web interface:

  • 120 points: Reporting all 15 measures and one readmission mensurate (if applicative)

  • 110 points: Reporting all xv measures (if no readmission measure applies)

Many quality measures utilize to family medicine, and so finding half dozen to focus on should not be difficult. Only choose advisedly. Your performance on these measures will affect your quality score, which in plow volition affect your last score and your payments. This commodity examines several factors to consider when selecting which quality measures to written report on, including how CMS uses benchmarks and decile scoring, the effects of "topped out" measures, criteria for reliable scoring, and how to earn bonus points.

Benchmarks and decile scoring

  • Abstract
  • Benchmarks and decile scoring
  • Topped out measures
  • Scoring requirements
  • Bonus points
  • Putting it all together

Information technology is logical to think that you lot should focus on quality measures where your performance is all-time. However, this is not necessarily the case considering your quality score is actually determined relative to a benchmark.

CMS has calculated a benchmark for each quality mensurate and submission method. These are based on actual operation values reported by physicians during the two years prior to the performance catamenia or, if that data is unavailable, during the performance period itself. Performance rates are broken down into deciles, and points are assigned based on where your performance falls relative to each benchmark.

For example, assume that your performance is 60 percent for breast cancer screening and xc percent for diabetes eye exam. (Encounter "Example of decile benchmarks for registry reporting.") Although your breast cancer screening performance was lower, y'all would receive more than points for this mensurate (7-seven.9 points) than for the diabetes eye exam measure (4-four.9 points) considering your breast cancer screening charge per unit falls into a higher decile relative to other physicians.

Spreadsheets of quality benchmarks for claims, registries, and EHRs for 2022 can be downloaded from CMS. Benchmarks for spider web interface submissions also are available.

Because this is a transition year, CMS has determined the lowest score for a specific quality measure will be three out of x points, fifty-fifty if functioning in that measure is 0 percent.

Learn well-nigh these benchmarks to amend sympathise how your performance on specific measures will bear upon your MIPS quality score and choose appropriately.

Case OF DECILE BENCHMARKS FOR REGISTRY REPORTING

In this example, even though a doctor'south performance of xc percent on diabetes center exams is higher than his 60 percent on breast cancer screening, the md would receive more points for breast cancer screening considering his operation rate falls in a higher decile.

Measure proper noun

Decile 3 (3-3.9 points)

Decile iv (iv-four.9 points)

Decile 5 (5-5.9 points)

Decile six (half dozen-6.9 points)

Decile 7 (7-7.9 points)

Decile viii (8-8.ix points)

Decile 9 (nine-9.9 points)

Decile 10 (ten points)

Chest cancer screening (%)

14.49-24.52

24.53-35.70

35.71-46.01

46.02-55.06

55.07-63.67

63.68-74.06

74.07-87.92

>87.93

Diabetes heart exam (%)

69.39-89.68

89.69-95.95

95.96-98.72

98.73-99.99

–

–

–

100

Topped out measures

  • Abstract
  • Benchmarks and decile scoring
  • Topped out measures
  • Scoring requirements
  • Bonus points
  • Putting it all together

For some quality measures, physicians' operation levels are so high and unvarying that CMS may decide that meaningful distinctions and improvement in performance can no longer be fabricated. CMS will review the measures each year to identify which ones are less desirable for quality reporting and label them every bit "topped out." Half of the current QPP quality measures are topped out, with several having a median score of 100 percent. If yous decide to report a topped out measure, it is likely you will demand a very high performance rate to score in the top decile and maximize your points. (See "Topped out 2022 MIPS measures for family medicine.")

CMS is considering several ways to discourage physicians from reporting on topped out measures, such as removing them from the list of MIPS quality measures, awarding fewer points for them, or limiting the number of topped out measures that physicians can report on. The bureau will likewise consider whether removing the topped out measures may decrease overall performance rates.

TOPPED OUT 2022 MIPS MEASURES FOR FAMILY MEDICINE

The following quality measures are considered "topped out" for certain data submission methods, meaning there may exist limits on how they are scored in future years.

Measure Submission method(s)

Urinary incontinence: plan of care for urinary incontinence in women aged 65 years and older

Claims, registry, Qualified Clinical Data Registry (QCDR)

Acute otitis externa: systemic antimicrobial therapy – avoidance of inappropriate utilise

Claims, registry, QCDR

Osteoarthritis: function and hurting assessment

Claims

Avoidance of antibody handling in adults with astute bronchitis

Registry, QCDR

Diabetes: eye exam

Claims, registry, QCDR

Documentation of current medications in the medical tape

Claims, registry, QCDR, electronic health record (EHR)

Falls: risk assessment

Claims

Falls: program of intendance

Claims

Elder maltreatment screen and follow-up plan

Claims

Preventive intendance and screening: tobacco utilise: screening and cessation intervention

Claims

Employ of imaging studies for low-back pain

Registry, QCDR, EHR

Atrial fibrillation and atrial flutter: chronic anticoagulation therapy

Claims

Developed sinusitis: CT scan for acute sinusitis (overuse)

Registry, QCDR

Developed sinusitis: more ane CT scan within xc days for chronic sinusitis (overuse)

Registry, QCDR

Scoring requirements

  • Abstract
  • Benchmarks and decile scoring
  • Topped out measures
  • Scoring requirements
  • Bonus points
  • Putting it all together

It is important to submit performance data that tin can be reliably scored. CMS requires that three criteria be met:

  1. Be compared to a national benchmark. Yous tin can determine which measures take a criterion by reviewing the CMS downloadable tables referenced earlier. For CMS to calculate a measure out's national benchmark, at least 20 entities must report the measure for at least 20 cases each and run across the data abyss standard, which is explained later.

  2. Include data for at to the lowest degree 20 cases. Physicians who outset before in the functioning period will take an easier fourth dimension coming together the instance minimum.

  3. Meet the data abyss standard. This depends on the method of reporting. (See "MIPS data completeness standards for 2017.") Submissions involving Qualified Clinical Data Reporting (QCDR), qualified registries, or EHRs in 2022 must study on l per centum of all patients, regardless of payer, seen over a ninety-day menses. Submissions involving claims, on the other mitt, must report on l percent of Medicare Role B patients for at to the lowest degree 90 days. Submissions involving web interface or CAHPS must report on a CMS-generated sample of Medicare Role B patients.

Quality measure data that see these three criteria will be scored based on performance and receive upwardly to ten points. Submissions that fail to meet ane or more of the criteria volition still receive 3 points in 2017. (Notation: Measures submitted through the spider web interface are an exception; measures that lack data completeness will receive a score of 0 while measures that practise not see the example minimum or have a benchmark will non be scored.)

In future years, CMS will revisit whether to honor three points – or fewer – for submissions that do not meet these three criteria.

MIPS DATA COMPLETENESS STANDARDS FOR 2017

Reporting method Data completeness

Claims

50 percent of Medicare Part B patients for the operation period (at least 90 days)

Qualified Clinical Data Registry, registry, electronic health record

50 percent of patients across all payers for the performance menses (at least 90 days)

Web interface

Sampling requirements for Medicare Part B patients

CAHPS for MIPS survey

Sampling requirements for Medicare Part B patients (Note: CAHPS can count as a quality measure for whatsoever MIPS reporting method.)

Bonus points

  • Abstract
  • Benchmarks and decile scoring
  • Topped out measures
  • Scoring requirements
  • Bonus points
  • Putting it all together

If you report on certain high-priority measures or use terminate-to-stop electronic reporting techniques, y'all can receive bonus points. In fact, you can potentially increase your quality score by up to twenty percent, which would help offset lower performance scores.

Data submitted for these measures must meet the 20-case minimum and information completeness requirements detailed earlier, and you must accept a performance rate greater than 0 percentage. Also, bonus points may be earned even if a mensurate is topped out or non scored.

High-priority measures. MIPS awards bonus points for reporting on measures involving outcomes, appropriate use, patient rubber, efficiency, patient feel, and care coordination. Physicians and physician groups already must report on one outcome mensurate equally role of the six required quality measures. For each additional event measure you report on, you lot receive 2 bonus points. You too receive two bonus points for reporting on patient experience measures. The other high priority measures earn one bonus betoken apiece.

Twenty-five measures from the family medicine specialty set are eligible for high-priority bonus points. You can place them past using the search option on the CMS QPP website and filtering for full general practice/family medicine and high priority measures.

End-to-stop electronic reporting. To qualify for this bonus, a registry, QCDR, or EHR must obtain your data from Certified Electronic Health Record Technology (CEHRT) and and then use automatic electronic systems to aggregate, calculate, filter, and submit the information to CMS in a standard format. End-to-terminate reporting is bachelor for all reporting mechanisms except claims-based submissions and is non specific to sure quality measures. Instead, it applies to whatsoever measure where the submission pathway is fully electronic subsequently the data is initially captured in CEHRT. Whatsoever process that involves manual extraction and re-entry of data does not qualify as end-to-end electronic reporting.

Each bonus point option has a 10 pct cap. For most family physicians, this means a limit of six to 7 bonus points for high-priority measures and half dozen to seven bonus points for stop-to-finish electronic reporting.

Putting it all together

  • Abstract
  • Benchmarks and decile scoring
  • Topped out measures
  • Scoring requirements
  • Bonus points
  • Putting it all together

This article has discussed four factors to consider when selecting and reporting quality measures and how each can affect your quality category score under MIPS. Other factors must exist considered as well, such every bit reporting method (claims, qualified registry, QCDR, EHR, web interface, or CAHPS survey) and ease of data collection, although these do not directly affect scoring. To come across a comprehensive scoring instance, see "Quality category scoring example."

It is important to remember that yous tin can report as many measures equally you want, just CMS volition only use the top half dozen scores to calculate your quality score. However, whatsoever reported measure that includes at least 20 cases and meets the data completeness threshold tin be reported publicly by CMS on its Doctor Compare website, and then this may influence whether you lot report actress measures.

The rules for implementing MIPS will evolve, equally volition physicians' strategies to optimize scores. For instance, CMS intends in the hereafter to score comeback every bit well equally accomplishment but has non yet said how. Meanwhile, as physicians become more experienced with MIPS, CMS will make the process more strict – for case by eliminating the three-point minimum for reporting measures, raising the 50 percent information completeness criteria to threescore percent or higher, and increasing the operation period from 90 days to a full yr. As discussed earlier, physicians may also receive fewer points for topped out measures.

To make quality improvement most helpful to your practice and your patients, you should prioritize measures that are relevant to your patient population, have the potential to touch your patients' health in substantial ways, amend the value of health intendance, and provide room for improvement. One time you identify these important measures, yous can determine which ones are best for you to written report on.

QUALITY CATEGORY SCORING Instance

The following is the quality measure scoring for a hypothetical physician who is not office of an Advanced Alternative Payment Model, who belongs to a group with xv or fewer clinicians, and who reported measures for at least 90 days in 2022 using a qualified registry. Ii of the lower-scoring measures ("advanced intendance programme" and "use of imaging studies for low back pain") are tossed out to accomplish the necessary six reported measures. Divided by the maximum potential score of 60, the physician's 54.5 points would give the physician a MIPS quality category score of 90.eight percentage. In 2017, any score above 3 will avoid a negative payment aligning.

Mensurate Met reliable scoring criteria? Percentile score Points Type of measure out High-priority measure bonus points Finish-to-end electronic reporting bonus points

Diabetes: hemoglobin A1C poor control

Yes

5.5

5.v

Outcome (high priority)

0 (no bonus for the starting time result measure)

1

Controlling high blood pressure

Yes

vii.ix

7.9

Upshot (loftier priority)

ii

ane

Advanced intendance plan (not used)

No

N/A

3 (score not amongst top six, discarded)

Care coordination (loftier priority)

0 (no bonus if mensurate can't be reliably scored)

0

Documentation of current medications in the medical tape

Yep

6.8

6.viii

Patient safety (loftier priority)

1

1

Preventive care and screening: tobacco use: screening and cessation intervention

Yes

9.0

ix.0

Population health

0

ane

Use of imaging studies for low dorsum hurting (not used)

Yes

iv.1

iv.one (score non amid top six, discarded)

Appropriate use (high priority)

i (bonus still awarded even though measure not used)

ane (bonus still awarded fifty-fifty though measure non used)

Breast cancer screening

Yeah

9.4

9.4

Effective clinical care

0

ane

Antibiotic treatment for adults with acute bronchitis: abstention of inappropriate utilize

Yes

4.9

four.9

Advisable utilise (high priority)

1

i

Full points

43.v (only the pinnacle six scores are used)

5

6 (bonus points capped at 10 pct of total possible points)

Final full

54.v points (out of threescore)

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Nearly the Writer

Sandy Pogones is senior strategist for health care quality at the American Academy of Family Physicians.

Author disclosure: no relevant financial affiliations disclosed.

Copyright © 2022 past the American University of Family Physicians.
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