By SONDA EUNUS, MHA, CMPE, CPB
MIPS, or the Merit-based Incentive Payment System, will have a significant impact on eligible Medicare clinicians in coming years. MIPS will measure clinician performance in 4 categories, and will assign each clinician a MIPS score that will then result in either a payment increase or decrease to the clinician's Medicare reimbursement. The 4 performance categories include Quality Measures, Cost and Resource Utilization, Advancing Care Information, and Improvement Activities.
In this article, we will explore the Improvement Activities category in more detail. Clinicians and practices will have over 90 different improvement activities to choose from to implement in their practice. The ultimate goal of this performance category is to improve the quality of patient care provided. There are several subcategories that these improvement activities fall in:
Achieving Health Equity
Behavioral and Mental Health
Beneficiary Engagement
Care Coordination
Emergency Response and Preparedness
Expanded Practice Access
Patient Safety and Practice Assessment
Population Management
Let's discuss these subcategories in greater detail.
Achieving Health Equity
This category wants you to provide quality care to patients while also taking into account social factors in health, such as income level, food security, employment, and housing.
Measure Example: Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare (IA_AHE_1)
Behavioral and Mental Health
This category emphasizes the importance of factoring in behavioral and mental health and its effect on the patient's overall well-being.
Measure Example: Diabetes screening for people with schizophrenia or bipolar disease who are using antipsychotic medication (IA_BMH_1).
Beneficiary Engagement
This category measures your efforts in engaging the patient's family to ensure that they fully understand the patient's condition and are included in important medical decisions and the development of a plan of care.
Measure Example: Engage patients, family and caregivers in developing a plan of care and prioritizing their goals for action, documented in the certified EHR technology (IA_BE_15).
Care Coordination
This category holds clinicians accountable for ensuring that the patient's care is coordinated among the different healthcare providers and facilities that are participating in his or her care, and that there is clear communication between all parties involved.
Measure Example: Timely communication of test results defined as timely identification of abnormal test results with timely follow-up (IA_CC_2).
Emergency Response and Preparedness
This category gets clinicians ready to respond in the event of a natural disaster or other emergencies, and to ensure that all employees and patients at the facility are protected from harm.
Measure Example: Participation in Disaster Medical Assistance Teams, or Community Emergency Responder Teams. Activities that simply involve registration are not sufficient. MIPS eligible clinicians and MIPS eligible clinician groups must be registered for a minimum of 6 months as a volunteer for disaster or emergency response (IA_ERP_1).
Expanded Practice Access
This category wants clinicians to make medical care as easily accessible to patients as possible, by opening longer hours or providing different means of communication with the practice.
Measure Example: Use of telehealth services and analysis of data for quality improvement, such as participation in remote specialty care consults or teleaudiology pilots that assess ability to still deliver quality care to patients (IA_EPA_2).
Patient Safety and Practice Assessment
In this category, clinicians must ensure that they are implementing processes that will ensure that safe and quality care is provided to patients across the board, at every visit. Also takes into account population health management.
Measure Example: Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs (IA_PSPA_16).
Population Management
In this category, you focus on patient populations with chronic conditions. You are encouraged to come up with initiatives that will benefit your targeted populations, as well as the local community that you serve.
Measure Example: Implementation of regular reviews of targeted patient population needs which includes access to reports that show unique characteristics of eligible professional's patient population, identification of vulnerable patients, and how clinical treatment needs are being tailored, if necessary, to address unique needs and what resources in the community have been identified as additional resources (IA_PM_11).
Which of these subcategories would be the most beneficial and feasible to implement in your practice?
Leading Management Solutions provides MIPS Assistance and Reporting services. Learn more here: www.lmsmips.com and download a free MIPS E-Book containing valuable information and links to useful resources.
Sonda Eunus, Founder & CEO of Leading Management Solutions has a background in managing a multi-location pediatric primary care practice, and truly enjoys medical practice management. She holds a Master of Healthcare Management, and a BA in Psychology. She enjoys sharing her work experience and knowledge of the healthcare field through her consulting work and her writing. She founded Leading Management Solutions, a healthcare management consulting firm, out of her desire to assist medical practice managers and physician owners in the successful management of their practices, by providing services that she herself needed while managing her practice. Along with a team of experienced and knowledgeable consultants, Sonda aims to make Leading Management Solutions a one-stop shop for medical practices by offering a variety of needed services that add great value to any healthcare organization. She can be reached at sonda@lmshealthpro.com
