A Complete Guide to MIPS Quality Measures

This guide includes 12 frequently asked questions aboutMerit-based Incentive Payment System (MIPS)质量的措施。使用这12个问题和答案来增加您对MIPS质量度量的理解，并为您的团队选择最好的MIPS质量度量。

1. Where can MIPS participants find a list of MIPS quality measures?
2. 什么是专业测量集?它们如何分类MIPS质量测量?
3. MIPS质量评估的提交方法是什么?
4. MIPS质量度量的分母是如何计算的?
5. MIPS质量测量的分子是如何计算的?
6. 在MIPS质量测量中，如何使用基准来给你的表现打分?
7. Other than benchmarks, what does CMS use to score your performance in MIPS quality measures?
8. 不同MIPS质量测量的负担是什么?
9. What is the documentation burden of different MIPS quality measures?
10. MIPS质量度量的度量管理员是什么?
11. What evidence do measure stewards use to create MIPS quality measures?
12. What are the types of MIPS quality measures?

#1 – Where Can I Find the Full List of MIPS Quality Measures?

Download the full list of MIPS 2020 quality measures fromAble Health™. After downloading the list, you can filter by specialty-measure set, submission method, measure steward, measure type, and more (figure 1).

Not familiar with specialty-measure sets, measure stewards, and measure types? Keep reading and learn everything you need to know.

#2 – What Are Specialty Measure Sets and How Do They Categorize MIPS Quality Measures?

Specialty measure sets categorize the219 MIPS quality measures in 2020由专业。专业测量集包括与临床医生的专业知识和常规实践相关的测量。Some specialty measure sets include more measures than others (figure 2).

Measures in a specialty measure set are relevant, but not unique, to that specialty. For example, the specialty set for orthopedic surgery includesMeasure 130: Documentation of Current Medications in the Medical Record. Measure 130 is relevant, but not unique to orthopedic surgery.

While specialty measure sets help you find measures relevant to your specialty, know that your best measure(s) may be outside of your specialty measure set. You are not limited to the measures in your specialty set. And your highest performance might be in a measure not in your measure set.

MIPS质量评估的提交方法是什么?

MIPS参与者使用提交方法报告MIPS质量测量。MIPS offers four submission methods for MIPS quality measures: claims, EHR, registry, and theCMS Web Interface. No submission method can report all 219 MIPS quality measures. However, you should know that some submission methods offer more measures than others. Registry submission can report the most measures, often including 100 percent of measures in a specialty measure set. Here’s a comparison of measures counts for each submission method (figure 3).

You’ll find this same discrepancy in each specialty measure set. Your submission method may or may not include all the specialty-specific measures your physicians prefer. Below is a snapshot of the discrepancy across specialty measure sets (figure 4).

不同的提交方法为每种提交方法提供了不同的度量值。例如，胃肠病学专业测量集包括15个总测量值。在这一套中，电子病历提交包括15项措施中的5项。注册表提交包括所有15个措施—10个额外措施。通过注册提交的胃肠病学专家可以报告这些额外措施。然而，有电子病历报告的胃肠病学专家不能提交这10项额外措施。这些额外的注册措施是独特的胃肠病学，使他们更可取的胃肠病学在大多数情况下。

The extra measures offered by registry submission are normally specialty-specific measures. And that’s how submission methods may include or exclude specialty-specific measures your physicians prefer.

因此，在选择MIPS质量指标时，请注意您可以通过您计划使用的提交方法报告哪些指标。如果你的医生喜欢的测量方法无法通过该提交方法报告，你应该重新选择你的提交方法。

#4 – How Are Denominators Calculated for MIPS Quality Measures?

Measure denominators identify the number of patients eligible for a MIPS quality measure. Measure specifications identify eligible patients using age range, gender, diagnosis, treatment, procedure, and other factors. Broad criteria, like age, increase the number of patients eligible for a measure. On the other hand, narrow criteria, like low-volume procedures, decrease the number of patients eligible for a measure. Be aware of the implications of broad and narrow criteria.

Similarly, narrow criteria compartmentalize patients by specialty. That’s helpful if your specialists want specialty-specific measures, but you report as a group for a multi-specialty team. For example, your cardiologists won’t have to worry about measures with narrow denominator criteria like chemotherapy and your oncologists won’t have to worry about measures with narrow denominator criteria like Coronary Artery Bypass Graft (CABG).

Below are criteria examples, moving from broad to narrow:

• Age– Measure 113 – “Percentage of patients 50-75 years of age who had appropriate screening for colorectal cancer.”
• Age + gender– Measure 048 – “Percentage of female patients aged 65 years and older who were assessed for the presence or absence of urinary incontinence within 12 months.”
• Age + date range– Measure 110 – “Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization or…”
• Age + diagnosis-测量001:在测量期间，18-75岁的糖尿病患者中有A1c >的比例为9.0%。
• Age + diagnosis + another diagnosis– Measure 118 – “Percentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12-month period who also have diabetes or…”
• Age + treatment– Measure 238 – “Percentage of patients 65 years of age and older who were ordered high-risk medications.”
• Age + finding– Measure 128 – “…AND with a BMI outside of normal parameters…”
• Procedure– Measure 145 – “Final reports for procedures using fluoroscopy that document radiation exposure indices, or…”
• Age + procedure– Measure 044 – “Percentage of isolated Coronary Artery Bypass Graft (CABG) surgeries for patients aged 18 years and older who…”
• Diagnosis + treatment– Measure 143 – “All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy…”
• Event-措施046 - 18岁及以上患者从任何住院机构(如医院、熟练护理机构或康复机构)出院的百分比。
• Biopsy– Measure 249 – “Percentage of esophageal biopsy reports that document the presence of Barrett’s mucosa that also include a statement about dysplasia.”

#5 – How Are Numerators Calculated for MIPS Quality Measures?

Numerators are calculated for MIPS quality measures using the measure’s specifications. The measure’s specifications define when it’s too late to fulfill a measure (case unit) and what data can be used to calculate each measure (collection types).

What Are Case Units for MIPS Quality Measures?

In every quality measure, a measure case has a particular unit. These units include patients, periods, episodes, encounters/visits, and procedures. These units also determine when it is too late to complete a measure within the performance period (figure 6).

While all measures must be completed in the MIPS performance period, some measures have to be completed sooner than the end of theperformance period.

• Episode, encounter, and procedure units-你必须在特定的时间内完成这些措施。你需要提前做好准备，一旦情节、遭遇或程序开始，就完成分子事件。
• Patient and period units– you can complete these measures within a broader time frame. In fact, you can recall patients to complete the numerator event.

With patient-based measures, you’ll find an additional caveat. You need to look at whether the numerator event can be completed: A) anytime in the measurement period, B) within some time frame relative to any encounter, or C) at the most recent encounter or assessment.

在选择MIPS质量度量时，您需要将每个度量案例的单位与度量的基准结合起来考虑。一些度量基准有空白十分位数。在这些度量中，如果您的绩效百分比从100%下降到99.99%，您可能会损失2到7个百分点。你可以回忆病人和完整的分子事件在测量病人和经期单位。这样做可以让你的分数回到100%，恢复你的2 - 7分。另一方面，你不能用发作单元、偶遇单元和程序单元回忆病人完成分子事件。

What Are Collection Types for MIPS Quality Measures?

CMSdefinescollection types as “a set of quality measures with comparable specifications and data completeness criteria.” The key word in that definition is “specifications.” The word “specifications” is key because measure specifications dictate what data in your PM or EHR can be used to calculate measure results. And in that way, collection types dictate what data can and cannot be used to calculate your measure results.

根据收集类型的规定，您必须仔细收集PM或EHR中的分子数据。这是因为在收集类型所指示的数据参数之外，您无法获得所收集的合格分子数据。That’s true for every collection type except forCQMs，用于注册表提交的数据收集。注册表提交可以定制用于报告的离散数据字段。如果使用注册表进行报告，请与注册表代表讨论用于捕获分子数据的数据字段。

每个提交方法都有一个集合类型。但是，一个质量度量可能有多个收集类型。这是因为相同的质量度量可以通过多种提交方法报告。Figure 7 below that explains the hit-and-miss reality across submission methods (like the game of Battleship):

如果您使用索赔报告您的质量数据，只有记录在索赔中的数据将报告给CMS。Similarly, if you use your EHR file to report your data (theQRDA), only data documented in your EHR’s mapped data fields will be reported to CMS. In the example above, blue boxes represent those data fields. Data captured outside those mapped data fields will not be reported to CMS. And that decreases your performance. Finally, registries like Able Health have the option to use all discrete data fields in your PM and EHR. However, be aware that not all registries use all data fields.

As you would imagine, the use of different data between submission methods (and their corresponding collection types) creates different performance results. Consider this example comparing two submission methods for the same measure (figure 8):

比较表明，注册表提交的性能高于EHR。第90百分位的临床医生报告的EHR在67.60 - 84.98%之间。另一方面，报告该测量的第90百分位临床医生的注册率在96.41%到99.99%之间。这种差异可能是由于注册表提交在计算度量结果时可以使用更多的数据。

No submission method represents a universal scoring advantage. However, at the end of a year, you might notice a scoring advantage. CMS allows you to submit using the collection type most advantageous to your score.

除了评分优势之外，注册表集合类型还普遍节省了时间。这是因为注册可以适应医生的文件，而不是医生(或编码人员)适应报告要求。

#6 – How Are Benchmarks Used to Score Your Performance in MIPS Quality Measures?

基准将每个度量标准的提供者性能分为10个部分。这十个部分叫做十分位数。每十分位数代表10%的供应商在MIPS前一年的表现。你在每一个MIPS质量测量中获得的成就分数取决于你的表现在测量的十分位数中的下降。每十分位数都等于你的表现所获得的分数。

For example, a final performance falling into decile 8 earns between 8.0-8.9 performance points. A performance of 98 percent would land in decile 8 in the example below (figure 9):

Different measures have different benchmarks. Some are very different. Those differences create confusion, causing some MIPS leaders to make two common mistakes when reviewing measures and their benchmarks.

Mistake #1 – People Think Measures Are Difficult When They Are Easy

许多人认为，高基准反映出衡量标准的难度。考虑这个例子(图10):

People believe these benchmarks reflect a difficult measure. However, this is an easier measure and the benchmarks prove it. Each decile represents the actual performance of 10 percent of providers in previous years. With that in mind, the benchmarks show that 70 percent of clinicians finished at 100 percent in previous years (deciles 4-10). These benchmarks do not create a standard of perfection; they reflect perfection for 70 percent of providers who scored 100 percent.

Mistake #2 – People Think Measures Are Easy When They Are Difficult.

Many people believe low benchmarks reflect an easy measure. Consider the next example (figure 11):

人们认为，这些基准反映了一种简单的衡量标准。然而，这是一个更困难的衡量标准，而基准也证明了这一点。请记住，每十分位数代表10%的供应商在前几年的实际表现。考虑到这一点，这些基准显示，70%的临床医生在之前的测量期间(高达十分位数7)的表现没有超过25%。这些基准显示，70%的医疗提供者在进行这种测量时存在困难。

While you should review benchmarks when selecting MIPS quality measures, you should also know that you can’t gain a scoring advantage by cherry picking measures based on their benchmarks. Benchmarks are set by past clinician performance. That means your performance is compared to the performance of other clinicians, not an arbitrary scoring standard. That’s also true as it relates to one measure with two collection types. The two benchmarks were set by clinicians reporting the measure with either the same limitations and advantages.

#7 – Other than Benchmarks, What Does CMS Use to Score Your Performance in MIPS Quality Measures?

Beyond each measure’s benchmarks, CMS uses many other factors to determine the achievement and bonus points you earn for each measure. The list of factors includes: the presence or absence of benchmarks, a seven-point cap on topped-out measures, a high-priority designation, a bonus for end-to-end reporting, data completeness criteria, and case minimums.

You can see some of these factors in the scoring example below (figure 12):

How CMS Calculates Achievement Points for MIPS Quality Measures

• Benchmarks——见上图。
• No benchmarks– some measures do not have historical benchmarks. For that reason, CMS cannot award measure achievement points as normal. You could earn points as normal if theQPP能够使用当前性能期数据可靠地建立基准。但最坏的情况是，你提交的没有基准的测试可以获得3分。219项质量指标中，约有30%没有基准。参见上面例子中的质量# 394。
• Seven-point cap– CMS applies a scoring cap of seven points to measures that have been topped out for two or more consecutive years. The QPP considers a measure topped out when historical performance has been so high that meaningful distinction between clinicians can no longer be measured. You’ll find that approximately 20 percent of the 219 quality measures have a seven-point cap. See Quality # 320 in the example above.
• Case minimums –you earn a maximum of three points for measures you report that include less than the required cases (generally 20).
• Data completeness– you earn one point for measures you report that include less than the required data completeness criteria (generally 70 percent). However, if your group is a small practice, you earn three points.

How CMS Calculates Bonus Points for MIPS Quality Measures

I除了测量成就点，你的测量可能会获得额外的积分。你可以在你表现最好的六项指标和你提交的任何额外指标上获得加分。

• Reporting additional high-priority measures– you earn two bonus points for additional outcome or patient experience measures you report. Also, you earn one bonus point for additional high-priority measures that are not outcome measures. The QPP caps these bonus points at 10 percent of your quality denominator. And, know that you do not earn bonus points for the required outcome measure (or high-priority measure if no outcome measure is available).
• End-to-end measure reporting– you earn one bonus point for measures you report directly from 2015认证EHR技术(CEHRT)。You must report measures without any manual manipulation. The QPP caps end-to-end bonus points at 10 percent of your category denominator.
• 注意:QPP上限端到端奖励点在质量类别分母的10%。类似地，QPP将额外的高优先级措施的加分限制在质量分母的10%。这是两个独立的上限，结合起来高达20%的奖金在MIPS质量类别。

#8 – What is the Burden of Different MIPS Quality Measures?

有些措施会给你的临床医生带来很大的负担。另一方面，有些措施不会增加额外的负担。这些措施只是对已经存在的问题进行了量化。在选择MIPS质量测量时，考虑到医生完成测量的负担。

Here are some examples of measures that quantify clinical quality without adding a burden to your clinicians:

• Measures you’re already doing-与MIPS无关，您的临床实践可能已经遵循MIPS质量测量背后的实践指南。显而易见的是，除了你的常规实践之外，质量测量不需要额外的时间来完成MIPS。If you’ve not found any overlap, make sure you’re looking at thefull list of MIPS quality measuresfor 2020. Don’t limit yourself to the47 measures tracked in an EHR.
• Measures that quantify how much you don’t do something– measures intended to eliminate or reduce an activity require no additional time to complete. One example is Quality # 238: Use of High-risk Medications in the Elderly. Additionally, many of the 19 measures in the Efficiency-and-Cost-Reduction domain seek to curb overuse (stop or reduce clinical activities).
• Structure measures-通过正确的技术自动化，一些结构措施不需要额外的时间来完成。一个例子是质量# 137:黑色素瘤:护理的连续性-召回系统。另一个例子是质量#225:放射学:筛查乳房x线照片提醒系统。
• Outcome measures– outcome measures, including intermediate outcome measures, require no additional time to complete. That’s true if you’re already collecting the necessary clinical values to quantify the resulting state. For example, if your patient intake includes vitals, you can report for Quality # 236: Controlling High Blood Pressure.

不同MIPS质量措施的文件负担是什么?

Documentation varies by measure and the measure’s submission method. Some measure documentation burdens your clinical team and some doesn’t. Consider the documentation differences between measures and make sure your team can keep up. Documenting the measure is just as important as doing the measure. That’s because, like in medical billing, “if it wasn’t documented, it wasn’t done.”

在选择MIPS质量度量时，要考虑度量和集合类型(提交方法)之间的差异。

Differences Between Measures

一些措施要求临床医生记录几个数据点。其他措施没有。平衡每个度量的机会和机会成本。

Differences Between Submission Methods for the Same Measure

对于同一度量，不同的提交方法使用不同的数据字段。This question returns to an image shown previously in this guide:

The differences between submission methods creates a different level of documentation burden for your clinicians.

• Claims submission– you only earn credit for claims submitted with quality data codes like G-codes (e.g. G8420) or CPT II codes (e.g. 3036F). These codes quantify complex numerator events with a single input, making data entry as fast as possible.
• EHR submission– you only earn credit for only your EHR’s prescribed list of data fields that they have mapped to nationally recognized data standards like SNOMED CT, MEDCIN, ICD-10-CM, and LOINC. However, some of these EHR workflows (mapping) burden your clinicians unnecessarily. That happens when EHR’s poorly map user workflows to these elements. Or, the preferred workflow is not mapped.
• Registry submission– you earn credit for any discrete data, including the data fields not mapped by your EHR. That includes, but is not limited to, the claims and EHR data fields above. That comprehensive use of your data results in documentation flexibility for your clinicians. They choose the workflow that is the fastest and most efficient for them.

#10 – What is a Measure Steward for MIPS Quality Measures?

A measure steward is an organization that owns and maintains a measure. Pay attention to measure stewards because physicians may be more welcoming of quality measures stewarded by organizations they value.Able Health’s downloadable measure list确定每个MIPS质量度量的度量专员(图14)。

Measure stewards of MIPS quality measures are organizations like CMS, theNational Committee for Quality Assurance, theNational Quality Forum以及美国心脏协会。然而，这个列表还不止于此。你的医生所属的许多医学协会也是测量专员。

#11 – What Evidence Do Measure Stewards Use to Create MIPS Quality Measures?

Measure specifications detail the purpose of MIPS quality measures. That merit is described in two sections: Clinical Recommendation Statements and Rationale.

Here is an example from Quality #046: Medication Reconciliation Post-Discharge:

在这些部分的研究和统计使您能够资格和量化临床价值。例如，假设每月有1000名住院患者出院。我们也假设60%的出院病人是老年病人。《46号质量》中提到的研究表明，这1000名患者中有432人“在住院期间至少服用了一种药物”。在选择测量方法时，像这样确定、量化和比较临床价值。

#12 – What Are the Types of MIPS Quality Measures?

MIPS质量测量分为七种不同类型。由于各种宏观原因，衡量标准的类型很重要。首先，结果指标，包括中期和患者报告的结果指标，有两个加分项。第二，过程测度在未来几年更容易从MIPS中移除。第三，效率措施可以帮助你在成本方面表现得更好，并为共享节约和捆绑支付计划做好准备。最后，一些结构措施可以通过技术实现自动化。

Here’s a definition and example for each type:

• Process measures-为患者或由患者进行的临床活动的量化。一个例子是措施112:乳腺癌筛查。
• Outcome measures– a resulting health state of a patient reported by the clinician. An example is Measure 398: Optimal Asthma Control.
• Intermediate outcome measures-由临床医生报告的导致病人短期健康状况，进而导致长期健康状况的情况。例如“236措施:控制高血压”。
• Patient-reported outcome measures– a resulting health state of a patient reported by the patient. An example is Measure 375: Functional Status Assessment for Total Knee Replacement.
• Efficiency measures-在特定情况下适当使用临床活动。例如测量439:适合年龄的筛查结肠镜检查。
• Structure measures-提供高质量的医疗保健服务。一个例子是测量225:放射学:筛查乳房x线照片提醒系统。
• Patient-engagement and patient-engagement measures-病人对护理经验的反馈。一个例子是304测量:白内障手术后90天内患者满意度。

What to do Next

Make sure your list of MIPS quality measures is the very best selection for your team. You may want to replace one or more measures on your list using the measure-selection tips in this guide. And if you’re new to MIPS, follow these 12 FAQs sequentially in order to identify the best measures for your team.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. The Able Health Quality Measures Solution: Why a Comprehensive Approach Matters
2. The Medicare Shared Savings Program: Four Tools for Better Profit Margins and High-Quality Care
3. Putting Patients Back at the Center of Healthcare: How CMS Measures Prioritize Patient-Centered Outcomes
4. Healthcare’s Next Revolution: Finding Success in the Medicare Shared Savings Program

---

PowerPoint Slides

Would you like to use or share these concepts? Download the presentation highlighting the key main points.

Click Here to Download the Slides

A Complete Guide to MIPS Quality Measuresfrom世界杯葡萄牙vs加纳即时走地