Which Quality Measures Should you Report?

Here's How to Select the Measures That Will Maximize Your Success Under Medicare's New Quality Payment Program

Sandy Pogones, MPA, CPHQ

Disclosures

Fam Pract Manag. 2017;24(4):5-10. 

In This Article

Introduction

Family physicians in 2017 are in the first performance year of the Merit-based Incentive Payment System (MIPS), part of a new performance-based reimbursement program that will affect how much they are paid through Medicare in 2019 and beyond.

MIPS is one of two payment tracks under the Quality Payment Program (QPP), which was established when the Medicare Access and CHIP Reauthorization Act (MACRA) ended the sustainable growth rate formula of determining physician payment under Medicare.

By default, physicians will participate in the MIPS track unless they choose and qualify to participate in the second payment track as an Advanced Alternative Payment Model (APM) or meet several criteria for exclusion from the QPP, such as enrolling in Medicare for the first time this year, billing $30,000 or less per year in Medicare Part B charges, or seeing 100 or fewer Medicare Part B patients per year.

The 2017 reporting period for MIPS ends Dec. 31. The Centers for Medicare & Medicaid Services (CMS) will not require physicians to report a full year's worth of data in 2017, but they must submit some data to avoid a negative payment adjustment. Physicians should use this transition year to prepare for full participation.

MIPS adjusts physicians' Medicare Part B professional fee-for-service payments upward or downward based on how they perform in four categories: quality, cost, improvement activities, and advancing care information. Each category is scored separately, has its own measures and requirements, and is weighted for its contribution to the final score, with quality having the greatest weight at 60 percent. (See "2017 MIPS Performance Category Breakdown.")

The quality category, in general, requires physicians or physician groups to report data for at least six quality measures, including one outcomes measure, if reporting using claims, registries, or an electronic health record (EHR). Note that physicians can report much less for 2017 depending on how aggressively they plan to comply with MIPS in the first year. Groups that report using a web interface (a secure Internet-based data submission option for groups of 25 or more eligible clinicians) must report data for 15 measures for the full 12 months of 2017. Groups may contract with a survey vendor to report Consumer Assessment of Healthcare Providers and Systems (CAHPS) in place of one quality measure. Groups with at least 16 clinicians and at least 200 cases will also have a readmission population measure calculated for them. (See "Maximum Possible Points in Quality Category.")

Many quality measures apply to family medicine, so finding six to focus on should not be hard. But choose carefully. Your performance on these measures will affect your quality score, which in turn will affect your final score and your payments. This article examines several factors to consider when selecting which quality measures to report on, including how CMS uses benchmarks and decile scoring, the effects of "topped out" measures, criteria for reliable scoring, and how to earn bonus points.

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