Oct 9 / Jessica Sinclair

What does it mean to satisfy MIPS quality measures?

How do I meet provider quality metrics?

So often we hear that a focus on preventive services can help meet provider quality metrics but how exactly do we meet these measures? As an example, one component of the Medicare Annual Wellness Visit that targets several quality measures includes the 5-10 year preventive care plan that is intended to outline guidance on a patient-specific guideline-directed screening schedule. Though the 5-10 year care plan and the annual wellness visit themselves will not automatically address or improve provider quality metrics, we have the opportunity to address and help satisfy quality measures during these appointments.

For the Merit-based Incentive Payment System (MIPS) performance year 2020, there are a total of 219 quality measures for the program and quality measures account for 45% of a provider’s total composite score. While providers do not have to report on all quality measures, practices are required to submit data for a minimum of six quality measures or complete a specialty measure set for general reporting requirements.

When collaborating with a provider for collaborative clinical services, it is important to be familiar with the quality measures being targeted by the practice and how you can address these metrics while offering services, such as the Annual Wellness Visit, Chronic Care Management, and Remote Physiologic Monitoring. Some electronic health records (EHRs) provide detailed explanations of how to specifically address and “satisfy” quality measures directly within their platform whereas in other systems, it can be complicated to locate this information.

The Quality Payment Program website includes detailed information on the different quality measures, reporting requirements, submission options, and resources for practices on how to get started. In addition, there is a place to access quality measure types, descriptions, instructions, and additional information on the evidence behind the quality measures. These details can be found as part of the Medicare Part B Claims Measure Specifications and Supporting Documents. These files include details on how performance is measured and how to improve provider scores by addressing these metrics.
Knowledge is power when it comes to collaborating with practices for collaborative clinical services. Serve as a valuable resource to the team by familiarizing yourself with the details of satisfying the quality measures being targeted by your practices!

1. U.S. Centers for Medicare & Medicaid Services. Quality Payment Program. Available at: https://qpp.cms.gov/. Accessed October 9, 2020.

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