Overview of CMS MIPS Quality Measures for LPTAC Medicine
Introduction
This article explores the quality measures set by CMS (Centers for Medicare and Medicaid Services) under the MIPS (Merit-based Incentive Payment System) framework for LPTAC (Long-Term Post-Acute Care) medicine. Before delving into the specifics of these measures, it is essential to understand their purpose and objectives.
Purpose of CMS Quality Measures
Enhancing Healthcare Delivery
CMS is committed to advancing healthcare policies that enhance service delivery. The newly introduced quality measures aim to improve overall healthcare outcomes while rewarding clinicians for effectively engaging with patients, families, and caregivers.
CMS’s Vision for MIPS
CMS emphasizes the importance of ongoing education and support. They aim to ensure that the Quality Payment Program benefits all stakeholders by providing clinicians with the necessary tools and resources to enhance their practices and improve quality. This support also assists clinicians in progressing towards participation in Alternative Payment Models (APMs) when appropriate.
Key Strategic Objectives of Medicare and Medicaid Services
Strategic Goals
CMS has established several strategic objectives to guide their efforts:
1. Enhance patient engagement and improve beneficiary outcomes.
2. Promote clinical experiences that provide both flexibility and transparency.
3. Address the diverse needs of physician practices, particularly those with smaller operations.
4. Improve IT systems to meet various data requirements for end-users, including reporting and submission needs.
5. Advance information sharing to ensure timely access to data.
6. Enable tailored communication while adhering to MIPS quality measure specifications.
Caveats for Individuals and Groups
MIPS Quality Measures Considerations
The new MIPS quality measures account for two LTPAC setting codes, which form the foundation for the specifications applicable to both individuals and groups.
Eligibility Criteria for MIPS Incentive Payments
Requirements for Reporting
To qualify for MIPS incentive payments, clinicians must meet specific criteria, including:
– Reporting on at least six measures, with one being an outcome measure related to diabetes control.
– Ensuring that each measure’s applicability spans a minimum of 90 days.
– Having approximately 50 percent of patients qualify for one of the six measures.
– Meeting a minimum threshold of 20 patients for incentive eligibility.
– Being mindful that some measures can only be reported after a specific diagnosis is established.
Avenues for Submission
Submission Methods
Clinicians can submit their measures through various channels, including EHR (Electronic Health Records), claims, QCDR (Qualified Clinical Data Registry), and Registry. The Registry option is particularly beneficial for groups reporting individual measures.
Advantages of Using Registry for Submission
Utilizing the Registry for submissions offers several advantages:
– All 2017 Quality Measures (QMs) can be submitted via the Registry, eliminating reliance on other reporting methods.
– Claims Reporting for 2017 QMs supports only a subset, making it essential to verify whether claims support is available or if the Registry should be used.
– The Registry allows groups to review and control measures before data submission, providing an opportunity to rectify any errors.
Avoiding Penalties
Maintaining Benchmarks
Clinicians should always keep benchmarks in mind to minimize the risk of penalties. Adhering to these benchmarks also helps fulfill base reporting requirements for MIPS. Ensuring that submitted data for each patient meets the respective quality measure can set a standard for others. Successfully fulfilling all six measures may result in a clinician’s data being featured on CMS’s Physician Compare site.
Differences in 2017 MIPS Quality Measures
Increased Detail and Benchmarking
The 2017 MIPS program introduces detailed benchmarking that relies on a methodology involving various performance points. These points contribute to a total score, making performance a critical focus for the year. Physicians must understand how their performance is evaluated in comparison to previous years and select quality measures that will enhance their scores.
CMS’s Commitment to Flexibility
CMS articulates its approach by stating, “By developing a program that is flexible instead of one-size-fits-all, we’re trying to meet clinicians where they are so that they can make the choice about how to participate in a way that is best for them, their practice, and their patients. Reducing burden, ensuring flexible program design, and improving how we measure cost and quality performance supports clinicians in doing what they do best – making their patients healthy.”