Part 2 – Top 5 MIPS Issues for Specialty Clinicians

May 11th, 2017 by

Another area of concern for specialty clinicians is around deciding which is the best Quality reporting method. Since Quality represent 60% of most eligible clinicians MIPS score, choosing the right reporting method is a significant part of a MIPS strategy. In this blog, I’ll take a look at how the reporting method you choose can impact your MIPS score.

2. What is the most suitable Quality reporting method?

Quality reporting method selection and measure selection are perhaps the two most prevalent MIPS issues facing specialty clinicians today. The MIPS quality category comprises the largest proportion of the 2017 MIPS score (60% for most eligible clinicians), and in the field, we see the greatest variations across clinicians in MIPS Quality performance as compared to other MIPS performance categories.

There are at least 8 different Quality reporting methods under MIPS (more if you distinctly count different submission file formats, CAHPS reporting, etc.). Each method constrains the measures that are available to select (hence, the relation to measure selection). In addition, different methods may require different data sources and data extraction techniques to be applied. For instance, EHR Direct requires that each ambulatory certified EHR produce submittable QRDA-3 files for each clinician or group; no paper records are acceptable. On the other hand, qualified registry may necessitate the extraction of data from both EHRs and paper records in order to satisfy minimum data requirements.

These facts combined with a myriad other differences among the reporting methods make selecting the right one challenging. Per issue #1 discussed in Part 1 of the series, the difficulty is especially acute for a specialty group trying to lobby for its preferred reporting method within a multi-specialty organization which only has the resources to use one reporting method for all clinicians. For example, some specialists are members of specialty societies offering specialty-specific reporting methods, most often qualified clinical data registries (QCDRs). However, it can be a significant effort to optimize and integrate a multi-specialty organization’s generic EHR to support a specialty-specific QCDR. And, if multiple specialties are vying for the organization to integrate with their desired QCDRs, then the complexities multiply.

We have also encountered specialists who are being forced by MIPS to find a reporting method different from what they used under legacy PQRS. In particular, many specialists used the qualified registry measures group method through 2016 for reason of administrative simplicity (only required 20 patients to be reported). However, as this method has been eliminated under MIPS, those groups must now choose another reporting method.

What to do? The most important best practice is to look beyond the theoretical aspects of a given reporting method (aka “what is being sold to you”) by asking the nuts-and-bolts questions of what it is actually going to take to utilize any given method. Do this very thoroughly early in the decision process, not after a vendor contract has been signed. A common mistake is for the IT department to be brought into the discussion only after senior leadership has already made a decision based on non-IT factors.

In next week’s blog, we will highlight some additional best practices addressing the linked issues of Quality reporting method selection and measure selection for MIPS.

You can access the rest of the blog series by clicking below:

 

Tom S. Lee
Founder and CEO

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