Data-Informed MIPS Improvement Efforts Drive Improved Quality Scores and Increased Revenue

MIPS IMPROVEMENT RESULTS IN HIGHER INCENTIVE PAYMENTS

CMS通过向满足一定性能阈值的组织支付费用来激励医疗保健组织使用MIPS。通过提高MIPS达到卓越绩效阈值的组织，可以获得数亿美元的一部分奖金。¹However, CMS has continually increased the performance thresholds that participating organizations must achieve to avoid penalties and qualify for incentive payments.

DIFFICULTY IDENTIFYING OPPORTUNITIES TO INCREASE MIPS SCORES

Baptist’s MIPS scores were not as high as the organization desired, and the product it used to monitor and report MIPS performance could not be used for improvement. The product relied on an application programming interface, but it was a “black box” over which Baptist had minimal control. The product provided Baptist’s MIPS scores, but Baptist couldn’t drill down into the data to understand the reasons for its score, so the organization couldn’t identify improvement opportunities.

When the organization made process changes, it took weeks for the data to make its way through the system and for scores to update, making it difficult—and at times impossible—to evaluate the impact of process changes on outcomes. Furthermore, Baptist had minimal control over submission data and was unable to maximize MIPS scores and ensure the points assigned accurately reflected the expert care provided to its patients. The organization needed actionable, high-value data and analytics that would allow it to accelerate MIPS performance.

IMPROVING MIPS WITH ACTIONABLE, ROBUST DATA

To meet its need for actionable, robust, high-value data and analytics for both MIPS reporting and improvement activities, Baptist decided to sunset the previous product used at the organization and implement the Health Catalyst MeasureAble application. MeasureAble is a quality measures solution that combines complete data, measures, visualizations, and workflows (measurement, improvement, and submission) into one comprehensive system. MeasureAble calculates performance, displays a measure performance dashboard, and includes a submission engine that submits data directly to CMS.

After implementing MeasureAble, Baptist now has a single, actionable source of truth for MIPS. The comprehensive measures engine and data visualization dashboard allows Baptist to proactively monitor complete performance metrics across different levels of the organization. Baptist uses the analytics application as part of its daily operations to:

• Effectively monitor, improve, and submit quality performance data.
• 建立绩效目标。
• Determine the number of care gaps that must be closed to achieve the exceptional performance bonus.

With this data, the Baptist teams have the option to perform pre-visit planning activities to determine any gaps in care prior to the patient visit and is currently being used to identify any patient exceptions to the measures to accurately opt them out of the measure to impact performance. Additionally, Baptist visualizes performance for each measure, including current performance and the number of gaps that must be closed to meet improvement goals. The organization can drill down to the provider, population, and patient level, gaining actionable insights to close gaps and improve MIPS performance.

Using the analytics application, Baptist can identify why gaps were occurring and then intervene to correct performance. For example:

• 该组织获得了对MIPS措施的更好的理解，包括诊断代码、药物和排除和/或豁免标准的文件时间的重要性MIPS性能。浸信会为终端用户提供教育，包括供应商、实践领导者和一线团队成员，关于结构化笔记中离散数据捕获的重要性，以及如何确定文件序列影响MIPS性能。
• Some patients appeared to have gaps in care when the patient should have been excluded from the measure. The organization standardized the documentation of exceptions.
• Often, patients received appropriate care, but providers were documenting the care in free-text notes instead of discrete fields in the EHR. Baptist standardized and streamlined documentation expectations, created how-to guides for every measure, and ensured providers were aware of the documentation source for each measure.
• The organization identified that its EHR was missing codes that should have been available to meet measure requirements, so Baptist worked with its EHR vendor to add the missing codes.

可测量为我们提供了可操作的数据，我们可以使用这些数据来推动性能改进，最大化我们的MIPS分数。

Sara Brown, MBA, Practice Optimization Consultant, Baptist Health Care

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RESULTS

Baptist’s data-informed MIPS improvement efforts are delivering the desired results. The organization achieved the following results:

• 92.94-point composite MIPS score, achieving exceptional performer quartile performance, qualifying for the exceptional performance bonus, and increasing revenue.
• 38 percent relative improvement in MIPS quality score, the result of a 14.2-point increase in quality points.
• 90 percent relative increase in quality points for the number of patients 18 years and older with nonvalvular atrial fibrillation or atrial flutter who were prescribed warfarin or another FDA-approved anticoagulant drug for the prevention of thromboembolism.
• 18岁及以上、在12个月内诊断为冠状动脉疾病的患者中，先前有心肌梗死或当前或先前左心室射血分数< 40%，并接受β受体阻滞剂治疗的患者质量分数相对增加72%。
• 52 percent relative increase in quality points for the number of patients 18 years and older receiving an appropriate routine interval surveillance colonoscopy, who had a previous diagnosis of adenomatous polyp(s).
• 23 percent relative increase in quality points for the number of patients considered at high risk of cardiovascular events who were prescribed or were on statin therapy during the measurement period.

WHAT’S NEXT

Baptist continues to leverage the analytics application for improvement and is engaging specialty providers in improvement efforts. The organization is confident it will achieve the exceptional performance quartile again next year and bring in increased revenue by qualifying for MIPS incentives.

参考文献

1. Merit-based Incentive Payment System (MIPS) – What is MIPS? (n.d.)MD Interactive.Retrieved fromhttps://mdinteractive.com/MIPS

ADDITIONAL READING

• A Complete Guide to MIPS Quality Measures
• How to Eliminate the Burden of Provider Quality Measurement
• Certified Analytics Platform Enables Electronic Quality Measures Reporting
• Increased Visibility into Value-Based Performance Results in $2.1M in Additional Pay for Performance
• Population Health Analytics Enables Improved Quality Increasing Revenue by Nearly $1M