MIPS: Choosing the Right Quality Measures for Your Practice

Insights

Now that we have covered the basics of MIPS (read here), let’s get into the main focus- how to choose the right quality measures for your practice. Even if you do not plan on fully participating this year, you will need to in 2018. Picking the right quality measures for your practice can have a big impact on your score. Quality counts for 60% of your overall MIPS score and one bad measure can affect your overall performance and determine your incentive payout. You will need to determine the 6 best measures for your practice and don’t forget, one of them needs to be an outcome measure.

Getting started with determining your measures can be a little overwhelming. There are hundreds to choose from, different priority levels and different submission options. Keep in mind, I am writing this based off a registry submission. The first step is to go to the Quality Payment Programs website to see the full list of quality measures. Once you are here, you could go down the entire list and see what stands out to you... but I suggest filtering it by your specialty. They do not account for every specialty (Pain Medicine for example) but the majority should see theirs or one that is similar. This will narrow it down some, how much is determined on the specialty.

Now that you have it narrowed down to your (recommended) applicable measures, it is time to dive into the details. When you go into a measure it will you give you eight pieces of information:

1. Description of the measure.
2. Measure #- there will be multiple numbers for the different reporting mechanisms.
3. NQS Domain- you no longer need to worry about this as you did in PQRS.
4. Measure Type- THIS IS IMPORTANT! Most will fall under “process” but you need at least one “outcome” measure to have satisfactory reporting.
5. High Priority Measure- this will say yes or no.
6. Data Submission Method- PAY ATTENTION TO THIS... whatever reporting method you are using (registry for example) needs to be listed here or you cannot use this measure.
7. Specialty Measure Set- this lists all the specialties that this measure is relevant to.
8. Primary Measure Steward- this is typically who/what recommended the measure. You really need to look at three of them. #1 to see if the description is something you are already doing/could easily implement into your practice. #4 to make sure that at least one of your six measures is an outcome measure and #6 to see if the measure can be reported through your chosen reporting method.

Hopefully you are still following along because I am going to add in the next layer. Unfortunately, it is not as easy as just picking your six measures from this list. You need to also verify that the specifications match the procedures and office visits you perform. Each measure has certain qualifying CPT & ICD-10 codes attached to it. A lot of practices end up with less than ideal scores because of this. Many practices are unaware. You can get to the measure specifications by clicking here. You will need the corresponding measure #’s (2) from above to get to the specifications of your chosen measures.

Once you have pulled up your specification sheets, I recommended going through them in detail. They will give you a further detailed description and explain what accounts into your denominator (patients eligible for the measure) and numerator (patients who meet the measure requirements). This can be based off age, CPT code and/or ICD-10 code.
Now you are finally ready to pick the best quality measures for your practice. I wish it were as easy as just “picking six” but to ensure a satisfactory score there is a lot of work that goes into it. You may have to go through the process a couple of times to dcreate your own website today (1)etermine six quality measures you are fully eligible and capable to report on. If this is too much of a hassle or too time consuming for your practice, NCDS can put together a detailed MIPS Action Plan customized to your practice needs. Contact us today to get started.

My final note on MIPS quality measures: If you are familiar with PQRS reporting, you are aware that the requirement was to report on 50% of your eligible Medicare Part B patients. For MIPS, this changes from 50% of your Medicare Part B patients to 50% of ALL of you payers. So while the number of measures decreased from PQRS, I predict more work will be required to report on MIPS quality measures because it will be a higher patient volume.

Nicolette Jordan, Client Relations Manager