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    MIPS: How you will be measured going forward

    ‘Composite score’ incorporates quality performance, cost, EHR use, clinical practice improvement


    The composite performance score

    Example of payment adjustments where average MIPS composite score is 60MIPS creates a composite performance score to measure and benchmark all eligible clinicians with a complicated formula. The MACRA-defined categories (and their relative weight) that comprise this composite score are Quality Performance (50% decreasing to 30% in year 3), Cost (also known as Resource Use) (10% increasing to 30% in year 3), Advancing Care Information (25%), and Clinical Practice Improvement Activities (15%).

    Also see: MACRA proposed rule brings new decisions

    Each of the categories has its own measurement complexity, but the simplest way to think about MIPS is this: The Quality Performance category will inherit the framework of Physician Quality Reporting System (PQRS) measures and replace that program, the Cost category will inherit the framework of and replace the Value-Based Modifier (VBM) Payment program, and the Advancing Care Information category will inherit objectives and measures from and replace the meaningful use program. The Clinical Practice Improvement Activities category, which is a new area that I hope to discuss in a future article, involves attesting to activities or processes (from a large menu and only for a 90-day period) that have been widely recognized to improve the health of patients or populations such as care coordination, patient engagement, or patient safety. The individual category scores are multiplied by their weight to arrive at a single MIPS composite score for the performance period for each eligible clinician (or group).

    Quality Performance. This is the primary determinant of the MIPS composite score at program inception. CMS proposes to require six measures chosen from a menu of existing and new PQRS measures (some existing measures are proposed to be deleted). A clinician’s score on each quality measure is determined by actual performance compared to a historically derived benchmark for that individual measure. Urologists who have participated in the PQRS program to date can find their historical performance on measures in their quality and resource use report (QRUR) downloadable from the CMS website, and begin to understand how they will be scored under MIPS.

    Recommended: Is a ‘perfect storm’ heading for urology?

    While the proposed measures and specialty sets do include some new options for urologists, from a practical perspective, the measures available for Quality Performance reporting under MIPS will be determined by which measures are actually reportable via one of several methods. For example, if a clinician elects to submit quality measures through “EHR reporting,” that EHR would have to be certified for each measure so reported; many EHRs are currently certified for only a limited number of measures. Some EHRs may send information to a third party such as a qualified clinical data registry (QCDR), which in turn calculates the measures; that QCDR could not report on measures for which the baseline data is not available. Finally, MACRA calls for new measures to be added each year; it will take EHR vendors weeks or months to develop, implement, and certify new measures.

    Next: Cost, Advancing Care Information

    Robert A. Dowling, MD
    Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality ...


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