This content was excerpted from EyeNet’s MIPS 2019; also see the Academy’s MIPS hub page.
In 2017, which was the first year of MIPS, most ophthalmologists did remarkably well in the quality performance category. This was particularly true of those who had integrated their EHR system with the IRIS Registry, with 91% earning an exceptional performance bonus and 31% getting a MIPS final score of 100 points.
CMS has raised the bar. Because clinicians’ performance rates have improved over the years, the benchmarks for most quality measures have become more demanding, making it more difficult to get high scores. This trend has continued in 2019, which means that the scoring for more measures “stalls” before the 10th decile (see Table 6B, for an example of this). To add to the challenge, many measures are now capped at 7 achievement points (i.e., with a perfect performance rate, you would only score 7 achievement points). When a measure has had a 7-point cap for two years, CMS will consider removing it from MIPS the following year.
How the IRIS Registry can help. The Academy had the IRIS Registry approved as a qualified clinical data registry (QCDR) and—since 2015—has been developing new subspecialty-specific QCDR measures (see the IRIS measures in Table 7 and Table 8). As CMS starts to eliminate measures that have a 7-point cap, the QCDR measures will ensure that you will have ophthalmology-specific reporting options.
Bottom line for 2019. If you report the same quality measures as last year, and get the same performance rates, your quality score may be lower because of score stalling and 7-point caps. To help counteract this, review the quality measure tables to see which measures aren’t subject to such scoring limitations (even if they aren’t eye care measures), and work with office staff to make sure those measures are being performed and documented in line with the latest requirements.
Browse the quality measures. For integrated IRIS Registry–EHR reporting, see Table 7; for manual reporting via the IRIS Registry (no EHR needed), see Table 8; and for claims-based reporting, see Table 9.
Previous: Quality: How CMS Calculates Your Quality Score
Next: Table 6: Some Quality Measures Are Subject to Scoring Limitations
DISCLAIMER AND LIMITATION OF LIABILITY: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.
COPYRIGHT© 2019, American Academy of Ophthalmology, Inc.® All rights reserved. No part of this publication may be reproduced without written permission from the publisher. American Academy of Ophthalmic Executives® and IRIS® Registry, among other marks, are trademarks of the American Academy of Ophthalmology®.