In the spirit of the winter Olympic Games, where hard work and dedication can lead to a gold medal, let’s take a closer look at MIPS quality calculations, as these same traits can optimize a provider’s bonus for Performance Year 2018.
Not all Olympic athletes will medal and not all providers will qualify for the MIPS bonus. But both groups are expected to compete. (Providers, of course, get penalized if they don’t.)
And just as Olympians must have a solid understanding of what the judges are looking for in competition, providers should know what CMS is expecting from their performance reporting.
In figure skating, for example, where a triple axel is considered more difficult than a triple loop, a competitor may have skated a clean long program, but under the sport’s points system, competitors who fall down can still win if their program has a higher level of difficulty. Further, skaters can lose out by not incorporating enough jumps into their programs.
Reporting on MIPS quality measures is much the same. Each measure has its own calculations and is assigned a different weighting, and will therefore affect overall quality scores differently.
So, even if providers have a poor performance in a heavily weighted category like Preventive Care and Screening: Influenza Immunization (#110) via QCDR submission, their overall quality score could still be stronger than a solid performance in a less-weighted category, such as Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis (#116), or a measure without a benchmark, like Hemoglobin A1c Test for Pediatric Patients (#365).
And just like the skater not blending enough jumps into their performance, providers may get penalized for submitting data on fewer than six quality measures. In fact, CMS will conduct an eligible measure applicability (EMA) process to identify clinically-related measures providers could have submitted for, and should other measures be recognized, it could have major implications for the provider’s quality performance calculation and score.
CMS has also issued other quality rule changes that will impact scores in 2018 and beyond:
Further, providers should be aware of other key points when it comes to reporting quality measures:
More than the thrill of victory or agony of defeat, MIPS scoring has an even bigger impact on providers: it could affect their livelihoods. CMS makes all MIPS scores public, and in an age where everything from skating rinks to Zambonis are rated online, providers should make every effort to make sure they score well.
Have questions about your 2018 MIPS reporting? HealthEC is ready to help! Please contact us at (732) 902-0070 or email@example.com.