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Scoring well in quality measures has just become more difficult


Disclaimer: This blog article was written by an AdvancedMD partner. The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of AdvancedMD.

Quality Measures | AdvancedMD

Scoring well in quality has just become more difficult. Your quality score on each quality measure is based upon ‘Deciles’. Think of it as being graded on the curve. If you score a 95 on a test you think you have a good grade, but if class average on that test was a 98 you will get a poor grade. Scoring for quality measures is like this type of grading.

For example, Measure 047: Advance Care Plan is scored in the following manner if you report through a registry.

Your Score Your Decile
100 10
98.95 – 99.99 9
95.6 – 98.94 8
89.24 – 95.59 7
79.02 – 89.23 6
64.44 – 79.01 5
43.84 – 64.43 4
20.33 – 43.83 3

In this case a score of 95% is only worth approximately 7 points. For those reporting on claims the metrics are even worse.

Your Score Your Decile
100 10
99.7 – 99.99 5
97.46 – 99.69 4
84.39 – 97.45 3

When reporting on claims a score of 95 is only worth 3 points. Notice that there is no way to get 9, 7, or 6 points miss even one patient, and you are at the 5th decile. If you were already aware of the decile scoring and you looked at the data published by CMS earlier this year to select your measures, you are in for a bit of a surprise. On June 11, CMS sent out the following email:

The Centers for Medicare & Medicaid Services (CMS) is committed to transparency, data integrity and open communication with our stakeholders. Through our ongoing quality assurance efforts, we identified and corrected an error with the decile outputs affecting the 2021 historical quality measure benchmarks file. This issue affected every measure in the benchmarks file. As a result of the correction, the range of performance rates for a given decile have shifted down one decile.

For example:

  • The range of performance rates that were previously identified for Decile 5 (eligible for 5 – 5.9 points) now show correctly as the range of performance rates for Decile 4 (eligible for 4 – 4.9 points).
  • The range of performance rates that were previously identified for Decile 8 (eligible for 8 – 8.9 points) now show correctly as the range of performance rates for Decile 7 (eligible for 7 – 7.9 points).

This means whatever you though you would get for a particular measure may have decreased by 1 full decile. To achieve a perfect score in the quality portion of MIPS you need to earn a total of 60 points in quality. Earning 60 points has just gotten more difficult.

It is also important to remember that in 2021 you need to achieve a composite score of at least 60 points which is an increase from the 45 points needed to avoid a penalty last year.

With the year almost halfway gone, now is a good time to look at the measures you are reporting and see what your expected MIPS composite score would. You still have 6 months to work on improving your MIPS score for 2021.

Michael Brody, DPM
Dr Brody has been actively involved in Computers and Medicine since the 1980’s. Dr Brody as a Residency Director at a VA hospital on Long Island and was present as the VA moved from paper records to computerized records. During this time, he was exposed to the stringent rules and regulations that government employees need to adhere to when protecting patient information. He co-founded TLD Systems with Warren Melnick to create a platform that doctors who wish to work in private practice have a cost-effective method of implementing HIPAA compliance in their practices in a manner that does not interfere with their ability to practice medicine. He has served on the Health Information Technology Standards Panel (HITSP), the Standards and Interoperability Framework (S&I), as a member of the Ambulatory Care Committee at the Certification Commission on Health Information Technology (CCHIT), and numerous other organizations. He is currently a member of the Physicians Committee at the Healthcare Information and Management Systems Society (HIMSS) and a co-Chair of the EHR workgroup at Health Level Seven International (HL7)

Topic: EMR/EHR, MACRA/MIPS, Meaningful Use, Public Policy

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