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QPP MIPS 2020 Quality Measures Fact Sheet Part 1

QPP MIPS, MIPS Quality measures, MIPS data submissions

MACRA (The Medicare Access and CHIP Reauthorization Act of 2015) has revamped its policies that might have made clinicians frowned upon. QPP MIPS is an extension of its efforts and helps physicians understand the importance of quality of healthcare instead of volume.

You must know that QPP MIPS measures performance based on the following four factors.

  1. Quality of healthcare
  2. Cost of Healthcare
  3. Improvement Activities (IA)
  4. Promoting Interoperability (PI)

Annual Call for MIPS Measures

The process of the annual call for MIPS Measures requires feedback and suggestions from the following stakeholders of the healthcare industry.

  • Clinicians
  • Researchers
  • Consumer groups
  • Other stakeholders
  • Professional associations, medical societies that represent eligible clinicians

CMS asks from them to send in their considerations for the Quality category measures. It’s part of the selection process, and its purpose is to include as many relevant measures that are related to individual-level or in-group.

The participants also are supposed to send in their research. Based on the information, CMS (The Centers for Medicare and Medicaid) considers if the suggested measures are:

  • Feasible
  • Reliable
  • Evidence-based
  • Scientifically acceptable
  • Valid at the individual clinician level

It is also to be noted that they are not accepting the Government Performance and Results Act (GPRA) measures at the moment. These measures resemble Core Quality Measure Collaborative (CQMC) measure set and are already included in the program.

Where the CMS requires aligning measures with the expertise and value of medical practice, they also try to avoid data redundancy.  The authorities only accept measures that are unique and fit their criteria.

Moreover, the new measures are also made public for opinions for a certain time. The discussions on these measures play an important part in their acceptance in the final measure sets, which is revealed generally on November 1, before the start of the performance year.

What Accounts for Quality Measures?

MIPS Quality measures help to measure the outcomes of the patient interactions with the doctor and the systematic operations of the processes. Their end-goal is to be qualifying for any of the following factors.

  • Effectivity
  • Safety
  • Efficiency
  • Patient-centered
  • Equitability
  • Time

CMS Criteria to Pick Up the QPP MIPS Quality Measures

The Measure Application Partnership (MAP) under the National Quality Forum (NQF) works for this purpose and judges measures for the above-mentioned parameters. There is an annual meeting for MAP, where they give feedback on the Medicare programs.  Besides, they also present pre-determined measures via private meetings.

The selection of measures also reflects on the following aspects of the healthcare industry.

Effective Clinical Care: Refers to the effectiveness of the diagnostic, preemptive, or response treatments.

Patient Safety: It refers to the measures that address the safety of care outcomes or a structure of care delivery. It also measures the availability or absence of a well-put-together system that risk or secure the security of medical practice. Structure, process, or outcomes, all these factors can be gauged through this factor.

Communication and Care Coordination: It refers to the measures that address effective communication and cohesive interactions between stakeholders. Plus the coordination of healthcare with the other healthcare providers.

Person and Caregiver-Centered Experience and Outcomes: The related measures address the extent of engagement of the patient and his family with the healthcare system. It also refers to the experience and satisfaction.

Community and Population Health: It includes the measures that relate to the patient’s requirements and are commonly used.

Efficiency and Cost Reduction: As suggested from the name, the measures address the affordability of the diagnosis, treatment, and surgical procedures including the unnecessary or elective ones. It also counters to inefficiencies, frauds, and high prices.

Now, you must have realized how MIPS Quality measures are selected. The scrupulous data-driven efforts require a professional and special team that helps you understand the sensitivity of measures and their effect on your revenue cycle if you decide to report them.  Our team specializes in this matter, and our successful MIPS data submissions are proof of our accomplishment.  You can also improve your revenue cycle management by effective QPP MIPS reporting. Contact now to start planning!


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