How can you be successful with MIPS?
In 2018, the Quality performance category under the Quality Payment Program’s Merit-Based Incentive Payment System (MIPS) is worth 50% of the MIPS composite performance score. For success on this performance category, proper attention should be given to measure selection for maximum point earning potential.
Prior to 2018 and under the Physician Quality Reporting System (PQRS), measure selection primarily centered on 2 key components:
- Which CPT and Diagnosis codes were being billed to Medicare?
- What clinical quality actions were typically performed by the provider per the standard of care for their patient populations?
The CPT and Diagnosis code elements typically make up the denominator criteria for a measure, while the clinical quality action(s) associated with the measure are known as the numerator for the measure. Going forward under the MIPS, measure selection for the Quality performance category is no longer as “simple” as looking at which CPT and Diagnosis codes a provider/practice bills throughout the year and picking measures that employ those codes. It is critical that providers/practices examine the new and critical element of achievable points per measure. Measure selection should be a 5-pronged approach. In addition to the 2 components listed above, the following should also be considered when choosing measures for reporting:
- Ensure at least 1 measure is an outcome measure type. If no outcome measure is reportable by the practice or clinician, a high-priority measure can be used in lieu of the outcome measure
- Review the most recently released CMS MIPS Benchmark and deciles data to confirm that the maximum points (10 points) is achievable for each measure being reported on
- Bonus points under the quality category are available for reporting on certain measure types (outcome/high priority beyond the minimum requirement) as well as for using Certified EHR Technology (CEHRT) to report and submit quality measures
Outside of the above considerations for measure selection, there are additional pitfalls to avoid, which will result in a lower possible point earning potential:
- New measures lacking benchmark history from prior years will only offer 3 points maximum
- Providers or practices who fail to meet data completeness thresholds will only receive one or three points per measure, depending on the size of the practice
- Providers or practices who fail to meet the case minimum (20 cases) will only receive three points per measure
- Some measures are considered “topped out,” meaning that even very high performance rates result in very low point earning potential. To earn 10 points on a “topped out” measure, a perfect performance score would be required
To optimize the measure selection for a MIPS eligible clinician or group practice, it is recommended that you look beyond just the denominator and numerator criteria established for each measure. You should review the latest CMS benchmark and decile scoring sheet for each measure to ensure that you are choosing measures that have a maximum earning potential of 10 points each and that are not “topped out,” as defined above.
For more information, contact John Webb, MicroMD Client Insights Manager, to discuss how you can be successful with MicroMD and ReportingMD at your side.