Learn to Maximize Your Success in CMS' Quality Payment Program

FPM Offers Strategies for Choosing Quality Measures

August 09, 2017 12:27 pm Sheri Porter

Family physicians have a limited amount of time to devote to reading medical literature -- even when they have access to top clinical and practice management journals like those available through the AAFP.

[Clock face that reads 'Time for Success']

However, an article in the July/August issue of Family Practice Management titled "Which Quality Measures Should You Report?" deserves attention, especially from physicians who are actively involved in CMS' Merit-based Incentive Payment System (MIPS).

Author Sandy Pogones, M.P.A., a certified professional in health care quality and the AAFP's senior strategist for health care quality, told AAFP News that because her article is very detailed, it will be of most benefit to physicians who are relatively advanced in the area of quality reporting and are striving for the exceptional performance bonus.

In other words, digging a little deeper into how CMS computes those overall MIPS scores will help physicians maximize their success in the new Quality Payment Program (QPP).

Story Highlights
  • An article in the July/August issue of Family Practice Management aims to help physicians maximize their success in CMS' new Quality Payment Program.
  • The author notes that her article dives into the details of the Merit-based Incentive Payment System and will be of most most benefit to physicians who are already doing quality reporting.
  • The article give physicians actionable tips on how to improve their performance and scoring on quality measures.

Remember, under MIPS, CMS will adjust physicians' Medicare Part B fee-for-service payments up or down depending on how they perform in four categories: quality, cost, improvement activities and advancing care information.

The quality category requires physicians to report data for at least six quality measures.

"Many quality measures apply to family medicine, so finding six to focus on should not be hard," writes Pogones. "But choose carefully. Your performance on these measures will affect your quality score, which in turn will affect your final score and your payments."

Clearly, a better understanding of the program's intricacies will benefit family physicians and potentially could lead to an upward payment adjustment in the future.

Article Highlights

There's lots to cover when it comes to MIPS, so Pogones narrows her focus to specific areas where physician choices can make a difference.

For instance, she gives readers a crash course on benchmarks and decile scoring. "It is logical to think that you should focus on quality measures where your performance is best," writes Pogones. "However, this is not necessarily the case because your quality score is actually determined relative to a benchmark."

She goes over points, scoring and percentages, and provides links to relevant CMS spreadsheets for 2017. Pogones urges physicians to learn about these benchmarks to better understand how their performance on specific measures will affect their MIPS quality score, and then choose accordingly.

Pogones covers topped-out measures, scoring requirements and how to earn bonus points.

"If you report on certain high-priority measures or use end-to-end electronic reporting techniques, you can receive bonus points," says Pogones. "In fact, you can potentially increase your quality score by up to 20 percent, which would help offset lower performance scores."

She points out that 25 measures from the family medicine specialty set are eligible for high-priority bonus points, and she walks readers through how to identify those measures on CMS' QPP website.

The article includes several easy-to-follow charts that help explain complicated content and highlight important details on decile benchmarks, topped-out 2017 MIPS measures for family medicine and more.

"To make quality improvement most helpful to your practice and your patients, you should prioritize measures that are relevant to your patient population, have the potential to affect your patients' health in substantial ways, improve the value of health care and provide room for improvement," says Pogones.

"Once you identify these important measures, you can determine which ones are best for you to report on."

Drilling Down

In an interview with AAFP News, Pogones expanded on a few points covered in her article. Here are some highlights of that conversation.

Q. Is there one area in MIPS that tends to confuse participants?

A. Understanding the whole idea of benchmarks is really critical to succeeding in MIPS. Unlike CMS' Physician Quality Reporting System (PQRS) -- where all a physician had to do was report to avoid a penalty -- MIPS is a comparative program where a physician's performance is compared to that of peers.

Looking at your performance compared to benchmarks is key; you may have a very high performance rate on a certain measure, but if everyone else also has high performance, then you're not going to stand out from the crowd.

Q. How were benchmarks set?

A. CMS took historical data for measures that were reported in 2015 through each PQRS mechanism and divided them into deciles according to the score. Scores falling into higher deciles earn more points; scores falling into lower deciles earn fewer points. The goal is for physicians to maximize their scores.

Q. How can physicians use benchmarks to their advantage?

A. Physicians want to be high performers. Look at the benchmark tables CMS has published for the measures you're tracking, and see where your performance falls. If others are performing better, figure out what they might be doing that you are not, and then make some changes in your practice to improve your performance and drive your score into higher deciles.

Q. What are topped-out measures?

A. There are some measures -- often process measures -- where everyone is doing well. These are considered topped-out measures. This means there is very little room for improvement, so they not actionable and are of minimal value for improvement purposes.

You can still report a topped-out measure, but eventually CMS will limit the number of points you can earn for these and may retire them from MIPS.

Q. What deadlines should physicians keep in mind?

A. If physicians are going to fully participate in MIPS, then they need to start collecting data no later than Oct. 2 because that gives them a full 90 days before the end of the year. The reporting year ends Dec. 31, and the submission period starts on Jan. 1, 2018, for everything except claims data reporting.

Let me add that there is absolutely no reason why any physician should get a payment penalty based on 2017 reporting. To partially participate, a physician can pick just one measure. It can be as simple as looking at one patient with diabetes -- and then reporting one code on one claim that indicates the patient's most recent hemoglobin A1c level. That work could be done by the practice team in less than an hour.

Q. What's the most important take-away for family physicians?

A. First, if you intend to participate fully in MIPS -- that is for at least 90 days in 2017 -- read this article to help you further analyze measures to see how you can best maximize your overall score.

Secondly, reporting is only one part of a complete performance improvement plan. There's always room for improvement in patient care, and measurement is a necessary part of improvement. MIPS quality measures are evidence-based, and performing well demonstrates that you're doing what's best for your patients.

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