Prior to 2017 and under the PQRS, measure selection primarily centered on 2 key components:
1. | Which CPT and Diagnosis codes were the provider billing to Medicare?
2. | What clinical quality actions were the provider typically performing per the standard of care for their patient populations?
Those elements, along with certain NQS domain and cross-cutting requirements, narrowed down the available measures to a short list from which each provider could choose. Going forward under the Merit-Based Incentive Payment System (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 not only examine the measure eligibility and quality action requirements, but also the new and critical element of achievable points per measure. Measure selection should be a 4-pronged approach. In addition to the 2 components listed above, the following should also be considered when choosing measures for reporting:
3.| 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
4.| Review the MIPS Benchmark Results spreadsheet to confirm that the maximum (10 points) is achievable for each measure being reported on
The final step of reviewing the benchmark spreadsheet for the points available, is a critical piece of the measure selection puzzle. New measures, which lack benchmark history from prior PQRS years, will only offer 3 points maximum. Additionally, some measures are considered “topped out,” meaning that even very high performance rates could result in very low point earning potential. To earn 10 points on a “topped out” measure, a perfect performance score would be required.
For more information, contact John Webb, MicroMD Client Insights Manager, to discuss how you can be successful with reporting with MicroMD.