Exploring the Goldilocks Zone of MIPS Measures: Specialty Specific or MIPS Friendly

Although all the MIPS performance categories offer a wide variety of options and accommodations for physician practices of all sizes, the task of selecting the measures to report on for the Quality category is the toughest. So, how can practices figure out the best measures and Goldilocks performance rate?

The tale of Goldilocks and her penchant for finding things that are “Just Right” strikes a perfect chord with MIPS. On one hand Physician Organizations, healthcare thought leaders, and CMS are trying to find the right mix of incentives and penalties to move towards value-based care without putting undue burden on small physician practices. On the other hand, physician practices and healthcare organizations are trying to figure out how to make the best of the MACRA rule as it stands in 2017. Mark Hagland has captured this predicament very well in his recent article.

The Big Dilemma: Specialty Specific or MIPS Friendly

Although all the MIPS performance categories offer a wide variety of options and accommodations for physician practices of all sizes, the task of selecting the measures to report on for the Quality category is the toughest. CMS has defined Specialty Measure Sets for certain specialties to make it easier for the specialists to find the measures that are most relevant to their specialty. However, there is a problem. Many specialty-specific measures do not have benchmarks yet or are topped-out. The measures that don’t have a benchmark may yield only 3 points. The topped-out measure means that at least half of the clinicians reporting that measure have performance rate of 95% or higher (5% or lower for inverse measures). You can still earn maximum score of 10 points for that measure, but you need to be at 100% performance (or 0% for inverse measures). [Learn More About Topped-Out Measures] So, what can a specialty or multi-specialty practice do to maximize their MIPS score?

 

Simple Solution: Primary Care Measures

Although many specialists feel that there are not enough measures for them to report in order to earn the maximum MIPS score, they fail to see that there are certain primary care measures that they can report on. A few observant Cardiologists already realized this. In their recent article published in JAMA Cardiology, they highlight the importance of careful measure selection, and the role of submission method specific benchmarks for Cardiologists to do well in MIPS. They also emphasize the advantage of including relevant primary care measures in addition to Cardiology specific measures. This might come as a surprise to some, but no explanation is required once you look at the measure points for a given performance rate. Let us consider all the measures in the Cardiology Measure Set defined by CMS.

 

For Registry Submission Method

If we consider 80% performance rate for all, within the following ten measures, it turns out that a combination of Primary Care and Cardiology specific measures make up the top 6 to produce the highest Quality score 52.5 out of 60.

For Registry Submission Method : If we consider 80% performance rate for all measures in the CMS MIPS Cardiology set, the following 10 measures turn out to fetch the highest Quality score 52.5 out of 60.

 

For EHR Submission Method

If we consider 80% performance rate for all, within the following ten measures, it turns out that a combination of Primary Care and Cardiology specific measures make up the top 6 to produce the highest Quality score 60 out of 60.

For EHR Submission Method: If we consider 80% performance rate for all measures in CMS Cardiologoy measure set for MIPS, the following 10 measures turn out to fetch the highest Quality score 60 out of 60.

 

Noteworthy Observations

  • Note that for both Registry and EHR submission methods, the measure #128 -  Preventive Care and Screening- Body Mass Index (BMI) Screening and Follow-up appears in the top 10 high scoring measures is absent from the CMS Cardiology measures short-list. The list clearly mentions that it is non-exhaustive sample and all measures must be considered before making a submission decision.
  • Many Primary-Care measures appear in the top-10 performing measures for both Registry and EHR submission methods.
  • Although Cardiology is used as an example here, the same logic holds true for other specialties too.

 

Reasoning

The current Primary Care measures have a lot of room for improvement, and CMS is incentivizing providers with additional points to report these measures. It’s not all about the scores either. In the long run, it will help in closing the loop of care, and help providers deliver cost-efficient quality care. Although specialty measure sets defined by CMS serve as a great starting point, providers must explore other Primary Care measures if they are applicable for their practice.

How can practices figure out the best measures and Goldilocks performance rate?

The most intriguing thing about quality measures is that the same performance rate might not yield the same points for every measure. Even for a measure, points earned might not increase even with an increase in the performance rate. Chosen submission method, measure benchmarks, topped-out measures, case minimums, data completeness and bonus requirements all impact the MIPS score. Keeping track of all these factors in addition to delivering patient care can be quite overwhelming.

Same performance rate might not yield same points for every measure.

So, how can practices optimize their effort and get the best results in MIPS? Try out all applicable Quality measures for which you have the data. See how they compare for different submission methods for your practice. Goldilocks couldn’t use a simulator, but you can. MIPS Score Simulator shows the impact of any change in any quality measure performance rate on your MIPS payment adjustment instantaneously, which makes finding the highest leverage measures for your practice (the measure that yield the best score for you and have the greatest potential of score improvement) very easy. In addition to quality category, MyMipsScore takes you through all MIPS categories (IA, ACI, and Quality) step-by-step to help you maximize your Composite Performance Score.

To uncover more insights into MIPS that apply to your practice and you could utilize to maximize your MIPS score, schedule a Roadmap Session today.