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QPP MIPS 2020 Quality Measures Fact Sheet

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

You must know that submitting MIPS measures gauges 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 QPP MIPS Measures

The process of the annual call for MIPS Measures requires feedback. In this regard, the following stakeholders and their suggestions are of great value to the healthcare industry.

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

CMS asks 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 as there are related to individuals and groups.

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

Attention Clinicians

Please note 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.

When CMS requires aligning measures with the expertise and value of medical practice, they also try to avoid data redundancy.  The authorities only accept those measures that are unique and fit the 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 measure patient outcomes, i.e., their interactions with the doctor and the system. 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 MIPS Quality Measures

The Measure Application Partnership (MAP) under the National Quality Forum (NQF) works to select MIPS Quality measures. It judges measures for the above-mentioned parameters. In fact, 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 risks or secures the security of medical practice. Structure, process, or outcomes, all can be assessed 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 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. They also talk about their experience and satisfaction.

Community and Population Health:

It includes measures about patient’s requirements and is much common.

Efficiency and Cost Reduction:

As suggested by the name, the measures address the affordability of the diagnosis, treatment, and surgical procedures including the elective ones. It also counters inefficiencies, frauds, and high prices.

By now, you may have realized how MIPS Quality measures are selected. The scrupulous data-driven efforts require a professional team to understand the sensitivity of measures in addition to their effect on your revenue cycle. Our team specializes in reporting MIPS, and our successful MIPS data submissions are proof of our skills. Moreover, you can improve your revenue cycle management process via quality QPP MIPS reporting. Hence, don’t wait or procrastinate, instead, contact us now to get started.

The 2020 Quality Measures Fact Sheet Part 2

QPP MIPS Quality measures are not put into action without extensive research. They have a complete background and several checking points to address various elements such as feasibility, efficiency, and more.

The process starts from the Annual Call for Measures, where all stakeholders give their considerations.

The submitted measures are then made public to review via the rulemaking process before the final selection.

However, Quality measures related to QCDR (Qualified Clinical Data Registry) are not selected via this method and have separate selection criteria.

The following six domains qualify any suggested measure as a final measure in the Quality Measure Set.

  1. Patient Safety
  2. Effective Clinical Care
  3. Experience and Outcomes
  4. Efficiency and Cost Reduction
  5. Community/Population Health
  6. Person and Caregiver-Centered
  7. Communication/Care Coordination

Quality Criteria and Skill Gap Areas

CMS doesn’t accept measures that don’t meet the quality criteria of QPP MIPS and measures’ skill gap. The gap areas (as referenced from the CMS official website) include but are not limited to

  • Orthopedic
  • Surgery
  • Pathology
  • Radiology
  • Mental Health
  • Oncology
  • Palliative Care
  • Emergency Medicine
  • Criteria for MIPS Measure Selection

Relevant and Topped Out Measures

CMS encourages stakeholders to generate measures that are relevant to specialties or cover topped out measures. Here is a list of topped-out measures. They should take effect from the year 2020.

Let’s see how they impact the MIPS clinical reporting in the upcoming years.

For measures to be part of the final set, they should be:

  • Accepted by all the affected parties and stakeholders
  • Feasible and practical

Factually speaking, there are lots of reporting requirements to understand before moving ahead. Analyzing data, selecting the right measures, and compiling them in a suitable form is not easy. A MIPS consulting firm can do that for you within your budget.

Therefore, start availing chances of generating revenue and consult a professional service to relieve your administrative burden!


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