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:
- Measure #110: Preventive Care and Screening Influenza Immunization: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
- Measure #111: Pneumococcal Vaccination Status for Older Adults: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
- Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
- *Measure #130: Documentation of Current Medications in the Medical Record -- High-Priority Measure; National Quality Strategy Domain: Patient Safety (Claims, Registry, EHR, GPRO Web Interface, Measure Groups)
- Measure #226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention: Community/Population Health (Claims, EHR, CMS Web Interface, Registry)
- *Measure #407: Appropriate Treatment of Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia -- High-Priority Measure; National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
*Indicates high-priority measures
Inpatient Opportunities to Report
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:
- Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
- Measure #47 (NQF 0326): Care Plan -- National Quality Strategy Domain: Communication Care Coordination (Claims, Registry)
- Measure #130: Documentation of Current Medications in the Medical Record -- National Quality Strategy Domain: Patient Safety (Claims, Registry, EHR, GPRO Web Interface, Measure Groups)
- Measure #407: Appropriate Treatment of Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
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
- Measure #1 (NQF 0059): Diabetes: Hemoglobin A1c Poor Control -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
- Measure #47 (NQF 0326): Care Plan -- National Quality Strategy Domain: Communication Care Coordination (Claims, Registry)
- Measure #407: Appropriate Treatment of Methicillin-Sensitive Staphylococcus aureus (MSSA) Bacteremia -- National Quality Strategy Domain: Effective Clinical Care (Claims, Registry)
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).
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Key Resources
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