June 23, 2016

MIPS Quality Management will Change your World

EarthYour MIPS Composite Score will be more influenced by Quality Reporting than anything else.  First of all, the Quality Category counts as much as all three other categories combined.  Second, it will be the hardest to score well at.  Here’s my thinking:  

  1. Those of us already doing Meaningful Use should score very high – with a lot of 100% achievers, mainly because that is the standard we have already been meeting, and for 2017, not that much is new.
  2. CPIA is a lay-down-hand. With all the choices, and the low scoring bar, most should score 100% on this category as well.
  3. Cost could be a big variable, but only accounts for 10%. You could totally fail Cost and still score a composite 90%. 
  4. Quality is no longer a pass-fail function. Your score on Quality will be based on how your staff performs against national benchmarks. CMS will calculate and publish 10 layers (deciles) for each quality measure.  Each quality measure is worth a baseline of either 10 points, or 8.5 points (for “topped-out” measures where everyone already scores very well).  Each EC’s score for each of the 6 measures they select (or 18 measures assigned under your ACO) is ranked into the appropriate decile.  If you are in the third decile, you get 3 (of 10) points.  If you score in the 9th decile, you get 9 points.  (Lower values if you choose topped-out measures).

You can get a couple bonus points for selecting “high priority” measures, or for submitting your measures using an “end-to-end CEHRT” method. 

At the end, your overall MIPS Quality score is the addition of the individual scores for the measures you choose to submit.   Don’t expect to get 100% … this would require scoring in the top decile on every single quality measure. 

So when it comes to determining what impact MIPS will have on your Medicare reimbursement, the most important person in your organization will be those individuals who can most effectively analyze, select, and optimize your Quality Scores.  Whoever does best on Quality … takes Money away from those who do poorly on Quality.  It’s that simple. 

Jun 23, 2016 4:56:41 PM | A set of Documentation Guidelines, Attestation and Audit, MIPS and MACRA

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