Numerous publications have highlighted the need to measure and constantly improve quality in our healthcare system. Infectious Diseases (ID) physicians’ impact the quality of healthcare both at patients’ bedside but also through their infection prevention and antimicrobial stewardship activities that are focused on improving quality at the systems-level.The resources below are designed to help ID physicians understand the current state of quality improvement and the transition towards a value driven healthcare system that publicly reports providers performance and pays for high quality outcomes.
To satisfy the reporting requirements of the quality category for MIPS in 2017, eligible clinicians or a group practice must report quality data on six measures. Of the six measures, one must be an outcome measure. In cases where an outcome measure is not available for a participating clinician, a high-priority measure can be reported as a substitute. A high-priority measure is defined as an outcome, appropriate use, patient experience, patient safety, efficiency, or care coordination measure.
Please see the complete list of 2017 MIPS Quality Measures (.xls).
To assess a clinician's quality performance, each measure is assessed against its benchmark to determine how many points a clinician has earned for the measures submitted. These benchmarks are based on performance data submitted to PQRS in 2015. The benchmarks are specific to the type of submission mechanism: claims, QCDRs/registries, EHRs, and CAHPS. Please see the 2017 Quality Benchmarks .zip file to view and learn more about the benchmarks.
IDSA is aware of the lack of applicable quality measures to the ID physician and has voiced concerns to CMS regarding this troubling issue. IDSA is currently exploring initiatives to address the inappropriate evaluation of ID physicians by reviewing the feasibility of developing an IDSA-sponsored clinical data registry to promote the value of the ID physician. In the short term, as payment adjustments are increasing, -4% payment penalty for non-participation in MIPS for 2017, IDSA recommends members to report on the following measures to avoid the payment penalties, (Note: the measures indicated below assume that an ID physicians sees patients in the outpatient and inpatient setting. Those shown in bold below only apply to the outpatient setting).
IDSA Recommendation for Reporting Six Quality Measures:
There are a limited number of MIPS measures applicable to those clinicians who practice in the inpatient setting and rely largely on initial and subsequent hospital visit codes. Provided below is a list of these measures for 2017.
Note: In order to ensure compliance in the Quality component of MIPS, ID physicians should report on #130 – Documentation of Current Medications in the Medical Record as a standard practice incorporated in a typical inpatient E&M encounter. The specification language for measure #130 indicates that this measure should be done at each visit, however, only the initial patient encounter CPT codes apply to this measure. As well, some ID physicians may feel that reporting measure #47 - Care Plan may be appropriate for some patient cases. Please be aware that once a provider starts reporting any quality measure, CMS will expect that the provider will report the measure for at least 50% of the cases. Therefore, should an ID physician report measure #47 for an initial or subsequent inpatient visit, then that physician will be expected to report measure #47 for at least 50% of the initial and subsequent patient visits for which they bill. Please see the MIPS quality measure specifications for the specific requirements for each mentioned measure (.zip – 249.3MB).
Applicable Measures for 99221 - 99223:
For subsequent inpatient face-to-face encounters, CMS has identified three quality measures that are applicable, which are listed below. As stated above, there are times when an ID physician may discuss Advanced Care Planning with a patient. Should the ID physician want to report this as a quality measure, they should be aware that CMS will expect that they report it on at least 50% of the subsequent visit codes for which they bill.
Applicable Measures for 99231 - 99233
CMS has developed a claims measures single source identifier tool. This can assist clinicians in identifying potentially applicable quality measures for reporting by searching for diagnosis and/or encounter code. Please see the 2017 MIPS Individual Claims Measure Single Source Tool (.xls).
The charge of the IDSA Quality Improvement Committee (QIC) is as follows:
Ron Nahass, MD, FIDSA - Chair
Lillian Abbo, MD, FIDSA
Tamar Foster Barlam, MD, FIDSA
Dale W. Bratzler, DO, MPH, FIDSA
David Classen, MD
Joshua Eby, MD
Clare Gentry, MD, MS
Amy Ray, MD, MPH
Katherine Reyes, MD, MPH
Kay Schwebke, MD, MPH
Kathleen Sheridan, DO
David Wheeler, MD, FACP, FIDSA
Ann T. MacIntyre, DO - Clinical Affairs Committee Liaison
Lawrence P. Martinelli, MD, FIDSA - Board Liaison
Neil O. Fishman, MD - SHEA Liaison
Michael A. Horberg, MD, FIDSA - HIVMA Liaison
Andrés Rodríguez - Assigned IDSA Staff
Thomas Kim - Assigned IDSA Staff
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