What steps have you taken in your practice to increase access and improve quality, contain costs, and create a positive environment for your patients, your staff, and you? Having taken those steps, not only are you working toward achieving the Quadruple Aim, you also are participating in the new category, Improvement Activities (IA), of the Merit-based Incentive Payment System, or MIPS.
While we have always managed metrics, the continuing evolution of payment reform as evidenced by the Quality Payment Program (QPP) has, at times, felt like a rockslide bearing down on us. Our responses take a variety of forms: eyerolling, hand-wringing, expletives, refusal to participate, or maybe — just maybe — the realization that we have been monitoring, evaluating, and modifying our systems and practices all along. Briefly, your IA score is weighted 15 percent of your total MIPS score; and an IA score of 40 points equals 100 percent credit.
The IA category of MIPS, despite the wordiness of its title, gives us an opportunity to identify, clarify, and account for the things we do best. The nine subcategories and the approximately 90 activities distributed among those subcategories allow us to document our meaningful interactions and interventions for the health and well-being of our patients and their families. High-weighted activities are worth 20 points, and medium-weighted activities are worth 10 points.
Let’s focus on just a few of the activities listed – high-weighted activities that can contribute the most to your overall score.
Population Management: Document an individualized glycemic-treatment goal (that takes patient-specific factors into account and is reassessed annually) in 60 percent of medical records (year one) for outpatient Medicare beneficiaries with diabetes who are prescribed antidiabetic agents. If you are caring for a population of diabetic patients, you are doing this: providing patient centered care; educating patients and families according to their social, cultural, and linguistic determinants; and regularly monitoring, evaluating, and modifying their care plans.
Beneficiary Engagement: Collection and follow up on patient experience and satisfaction data on beneficiary engagement, including development of all improvement plan. Whatever you are using – a postcard with four basic questions, an iPad at checkout, or an emailed survey – you are collecting information that affirms your efforts to meet the needs of your patients and their families on many levels. This information also may indicate areas for improvement. When you share the information with your staff and make changes to your processes, you are developing your improvement plan.
Patient Safety and Practice Assessment: Consult the Prescription Drug Monitoring Program prior to the issuance of a Controlled Substance Schedule II (CSII) opioid prescription that lasts more than three days (in California, the C.U.R.E.S. database). You have made this action a standard part of your patient assessment and treatment plan, thus protecting the patient, the community, and yourself. Consulting the PDMP in your state reflects your commitment to patient safety and appropriate prescribing.
Let’s circle back to the goal of taking credit for what you do best. Underlying IA, as well as the other MIPS categories, is our old friend, documentation. And documentation is our friend. Precise, accurate, and timely documentation builds a foundation of bedrock to stand on and refer to. Precise, accurate, and timely documentation proves our point, makes our case, helps us get paid, and sees us through audits.
The nine subcategories and 90 activities in the Improvement Activities category of MIPS offer us a chance to shine a bright light on the energy, intelligence, creativity, and commitment physicians and staff bring to the care of their patients, families, and communities. Identify what you do best, document what you do, and tell the world – or at least tell CMS.
Carole Lambert is Vice President, Practice Optimization for CAP. Questions or comments related to this article may be sent to clambert@CAPphysicians.com.