Quality Performance Category - 2019 (Specialist)

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Video Time: 11:17

Weight to final score:

  • 45% in Year 3
  • Maintain the same reweighting criteria for the Quality performance category

 

Medicare Part B claims measures can only be submitted by clinicians in a small practice (15 or fewer eligible clinicians), whether participating individually or as a group.

 

Individuals can use multiple collection types

In Year 3, individual eligible clinicians can submit measures via multiple collection types (MIPS CQM, eCQM, QCDR measures, and for small practices, Medicare Part B claims measures).

If the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring.


Groups and Virtual Groups can use multiple collection types.

In Year 3, groups and virtual groups can submit measures via multiple collection types (MIPS CQM, eCQM, QCDR measures, CMS Web Interface measures for large practices, and Medicare Part B claims measures for small practices).

 

  • If the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring

 

EXCEPTION: CMS Web Interface measures cannot be scored with other collection types other than the CMS approved survey vendor measure for CAHPS for MIPS and/or administrative claims measures.

 

Data Completeness Requirements:

The same data completeness requirements as Year 2, with the following scoring change:

 

  • For groups that submit 5 or fewer quality measures and do not meet the CAHPS for MIPS sampling requirements, the quality denominator will be reduced by 10 and the measure will receive zero points.

 

Topped-Out Measures:

The definition and lifecycle for topped out measures remain the same for Year 3, although additional factors may affect the time a topped-out measure remains such as:

 

  • Extremely Topped-Out Measures: A measure attains extremely topped out status when the average mean performance is within the 98th to 100th percentile range. Such measures may be proposed for removal in the next rule-making cycle, and will not follow the 4-year lifecycle for other topped-out measures.
  • QCDR measures are excluded from the topped-out measure lifecycle and special scoring policies. If the QCDR measure is identified as topped-out during the self-nomination process, it will not be approved for the applicable performance period.

 

Measures Impacted by Clinical Guideline Changes:

  • CMS will identify measures for which following the guidelines in the existing measure specification could result in patient harm or otherwise provide misleading results as to good quality care.
  • Clinicians who are following the revised clinical guidelines will still need to submit the impacted measure. The total available measure achievement points in the denominator will be reduced by 10 points and the numerator of the impacted measure will result in zero points.

 

Bonus Points: High-Priority Measures (after first required measure)

  • Same as Year 2, with the following change:
  • Discontinue high priority measure bonus points for CMS Web Interface Reporters.

 

We also revised the definition of a high priority measure to include opioid-related measures.

  • A high priority measure is an outcome, appropriate use, patient safety, efficiency, patient experience, care coordination, or opioid-related quality measure.
  • Outcome measures would include intermediate-outcome and patient-reported outcome measures.

 

Bonus Points: End-to-End Electronic Reporting:

Same as Year 2

 

Improvement Scoring – Full Participation:

Same as Year 2

 

Small Practice Bonus:

  • The small practice bonus will now be added to the Quality performance category, rather than in the MIPS final score calculation
  • 6 bonus points are added to the numerator of the Quality performance category for MIPS eligible clinicians in small practices who submit data on at least 1 quality measure.

MACRA Acronyms, Terms & Definitions Explained for 2019

To help clarify some of the terms surrounding Medicare Access and CHIP Reauthorization Act (MACRA), the AMA has compiled a list of acronyms, terms and definitions.


A

ABC™ - Achievable Benchmark of Care

ACO - accountable care organization

AHRQ - Agency for HealthCare Research and Quality

APM - alternative payment model

APRN - advanced practice registered nurse

ASPE - HHS’ Office of the Assistant Secretary for Planning and Evaluation

AUC - appropriate use criteria

B

BPCI - bundled payments for care improvement

C

CAH - critical access hospital

CAHPS - Consumer Assessment of Healthcare Providers and Systems

CBSA - non-core based statistical area

CDS - clinical decision support

CEHRT - certified EHR technology

CFR - Code of Federal Regulations

CHIP - Children’s Health Insurance Program

CJR - comprehensive care for joint replacement

CMMI - Center for Medicare & Medicaid Innovation (CMS Innovation Center)

CMS - Centers for Medicare and Medicaid Services

COI - collection of information

CPIA - clinical practice improvement activity

CPOE - computerized provider order entry

CPR - customary, prevailing and reasonable

CPS - composite performance score

CPT - Current Procedural Terminology

CQM - clinical quality measure

CY - calendar year

D

DPP - diabetes prevention program

E

eCQM - Electronic Clinician Quality Measure

ED - Emergency Department

EHR - electronic health record

EP - eligible professional

ESRD - End-stage Renal Disease

F

FFS - fee for service

FQHC - federally qualified health center

FR - Federal Register

G

GAO - Government Accountability Office

GPCI - Geographic Practice Cost Index

H

HAC - hospital-acquired condition

HCAHPS - Hospice Consumer Assessment of Healthcare Providers and Systems

HHS - Department of Health & Human Services

HIE - Health Information Exchange

HIPAA - Health Insurance Portability and Accountability Act of 1996

HITECH - Health Information Technology for Economic and Clinical Health

HOPD - Hospital Outpatient Department

HPSA - health professional shortage area

HRSA - Health Resources and Services Administration

I

IHS - Indian Health Service

IPAB - Independent Payment Advisory Board

IT - information technology

L

LDO - large dialysis organization

M

MA - medical assistant

MAC - Medicare Administrative Contractor

MACRA - Medicare Access and CHIP Reauthorization Act of 2015

MedPAC - Medicare Payment Advisory Commission

MEI - Medicare Economic Index

MIPAA - Medicare Improvements for Patients and Providers Act of 2008

MIPS - Merit-based Incentive Payment System

MLR - minimum loss rate

MSPB - Medicare spending per beneficiary

MSR - minimum savings rate

MU - Meaningful Use

MUA - medically underserved area

N

NCQA - National Committee for Quality Assurance

NPI - National Provider Identifier

NQF - National Quality Forum

O

OCM - Oncology Care Model

OIG - Office of the Inspector General

ONC - Office of the National Coordinator for Health Information Technology

P

PCMH - patient-centered medical home

PCORI - Patient-centered Outcomes Research Institute

PECOS - Medicare Provider Enrollment, Chain and Ownership System

PFPMs - physician-focused payment models

PFS - physician fee schedule

PHS - public health service

PPS - prospective payment system

PQRS - Physician Quality Reporting System

PTAC - Physician-focused Payment Model Technical Advisory Committee

Q

QCDR - qualified clinical data registry

QIO - quality improvement organization

QP - qualifying APM participant

QPP - Quality Payment Program

QRDA - quality reporting document architecture

QRUR - quality and resource use reports

R

RAC - recovery audit contractor

RBRVS - Resource-based Relative Value Scale

RFI - request for information

RHC - rural health clinic

RIA - regulatory impact analysis

RVU - relative value unit

S

SGR - sustainable growth rate

T

TCPI - Transforming Clinical Practice Initiative

TIN - tax identification number

V

VBM - value-based payment modifier

VPS - volume performance standard