Essential Guide to MIPS Quality Measure Specifications 2019 Explained

Understanding Measure Specification in MIPS 2019

Definition and Importance

The term ‘Measure Specification’ refers to a comprehensive description of a measure. In the context of the 2019 MIPS Quality measure specifications, these guidelines provide essential information for MIPS-eligible clinicians who report Clinical Quality Measures (CQMs) through Qualified Clinical Data Registries (QCDRs) or Qualified Registries, as well as for groups reporting via Qualified Registries under the Quality Payment Program (QPP) for 2019. Each measure specification includes a measured flow and an associated algorithm to assist with data completeness and performance. It is important to note that while these specifications serve as definitive descriptions of measures, measure flows may not always receive attestation from the Measure Steward.

A Brief Recap of MIPS

The Merit-based Incentive Payment System (MIPS) is an evaluation framework established by CMS, enabling eligible clinicians to submit their performance data to maintain compliance and enhance their standing within the healthcare community. MIPS serves as a metric to assess the quality of care and clinician performance through the submission of designated measures or measure sets. Following the successful implementation of performance analysis in MIPS 2018, MIPS 2019 introduces new opportunities for clinicians. Understanding measure specifications is crucial, as they outline key details such as reporting frequency, respective codes, and other essential aspects of the measures.

Reporting Requirements for 2019

In 2019, eligible clinicians must report a minimum of six MIPS quality measures, which should include at least one outcome measure or a high-priority measure. They also have the option to report on a complete measure specialty or sub-specialty set.

New Developments in 2019

Enhanced Criteria for Performance Measurement

The government has introduced improved performance measurement criteria for 2019, providing clinicians with greater flexibility. Key changes include the addition of opioid-related quality measures to the high-priority measures list and expanded options for submitting the same measure through various collection types, such as QCDR, MIPS CQMs, CMS Web Interface, and Medicare Part B Claims Measures. This allows clinicians to select measures from different collection types that are most relevant to their practice.

Insights into 2019 MIPS Quality Measure Specifications

Guidelines for Submission

Clinical Quality Measure specifications outline the guidelines that clinicians must follow when submitting CMS MIPS quality measures. Each measure is identified by a unique identifier, ensuring continuity from measures used in the 2018 QPP. Measure Stewards have made adjustments to the list of MIPS quality measures based on previous performance years.

Frequency of Measure Submission

Frequency labels are integral to each measure’s execution plan and measured flow. These labels indicate how often a measure must be submitted. Each eligible clinician participating in MIPS 2019 must adhere to the specified submission frequency. The definitions related to frequency labels for the 2019 MIPS Quality measure specifications include:

– **Patient-Intermediate Measures**: Must be submitted at least once per patient within the performance year, using the most current quality codes for any additional submissions.
– **Patient-Process Measures**: Require at least one submission per patient during the performance year, with the most rewarding quality-data code used for multiple submissions.
– **Patient-Periodic Measures**: To be submitted at least once per patient during the performance year, with the highest quality-data code applied if submitted more than once.
– **Episode-based Measures**: Submitted once for each occurrence of an illness or condition throughout the performance year.
– **Procedure-based Measures**: Submitted each time a procedure is performed during the performance year.
– **Visit-based Measures**: Submitted for each patient visit to the MIPS eligible clinician during the performance period.

Performance Period Definition

The performance period for a measure typically spans from January 1 to December 31. Each measure specification includes various sections, such as Instruction, Description, or Numerator Statement, which detail the performance period.

Understanding Denominator and Numerator

Quality measures consist of a numerator and denominator that are utilized to evaluate data completeness, ultimately contributing to the final score of the MIPS-eligible clinician.

Role of P3 Healthcare Solutions

As a MIPS Qualified Registry, P3 Healthcare Solutions, located in Ontario, CA, assists clinicians in achieving scores above 75. Attaining such high scores in 2019 can significantly enhance a clinician’s reputation, respect, and potential income.

Conclusion

The QPP program plays a vital role in aligning with the evolving demands of the healthcare sector. Understanding and implementing the 2019 MIPS Quality measure specifications can empower clinicians to improve their practice and performance outcomes.