Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_39_2979 - Submission of MIPS Quality Metrics via Claims in a Radiation Oncology Practice

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Submission of MIPS Quality Metrics via Claims in a Radiation Oncology Practice
J. Y. Luh1, L. Iversen2, and D. M. Macdonald3; 1Providence St. Joseph Health, Eureka, CA, 2Iversen Medical Billing, Blue Lake, CA, 3Madigan Army Medical Center, Tacoma, WA

Purpose/Objective(s): Participation in the Medicare Access and CHIP Reauthorization Act (MACRA) involves either Advanced Alternative Payment Models or the Merit-Based Incentive Payment System (MIPS). Most physicians will participate in MIPS, consisting of four performance categories to determine positive, neutral, or negative payment adjustments. The Quality performance category was preceded by the Physician Quality and Reporting System (PQRS) program and now affects physician reimbursement based upon performance rates. The Quality performance category has a high clerical burden on small practices that lack administrative support or access to a Qualified Clinical Data Registry (QCDR). We explored submission of quality data by claims, a method felt to require the least data entry for physicians.

Materials/Methods: With the 4th quarter of the MIPS reporting period (starting 10/2/17 to 12/31/17), we selected seven measures from the CMS Quality Payment Program (QPP) website that could be submitted via claims. Measures were submitted with the appropriate current procedural terminology (CPT) code. Our billing sheet was configured to include these seven measures to be reported for each new patient consult (CPT 99201-5) and follow up visits (CPT 99212-5). Measure #156 was submitted with simulation (CPT 77295). Data on 148 patients was submitted.

Results: The measure reported on most frequently was #226 (tobacco use) with 100% of patients being screened for tobacco use and intervention offered for those were were current smokers. Measure #130 (current medications) and #110 (influenza vaccination) were tied at 80%. Measure #111 (pneumococcal vaccination) was the next most frequent at 74%. The measures related to screening were the least frequently reported (#112 Breast Cancer Screening at 15% and #113 Colorectal Cancer Screening at 41%). Unlike the PQRS Program which was a pay for reporting incentive program, the MIPS Quality Performance Category is a pay for performance program. When analyzing the performance rate for each measure, we achieved the following: #110 Influenza vaccination: 80% #111 Pneumococcal vaccination: 52% #112 Breast cancer screening age 50-74: 77% #113 Colorectal cancer screening age 50-75: 88% #130 Current medications 18 and older: 94% #156 Dose limits to normal tissues (for new starts only): 76% #226 Tobacco Use: Screening and Cessation: 97% Our online CMS MIPS Dashboard showed a score of 37.3 out of 60 possible points using this method. Measure #113 did not count towards the score.

Conclusion: Participation in the MIPS Quality Performance Category can be successfully achieved via claims submission without the need for purchasing access to a QCDR or other commercially available web-based registry. Computer data entry by physicians was also minimized. Despite only five measures being accepted, our seven selected measures allows radiation oncologists to meet the minimum requirement of 6 quality measures to participate in the Quality Performance Category of the MIPS Program.

Author Disclosure: J.Y. Luh: Independent Contractor; St. Joseph Hospital. Partner; Actimatech, Inc. Honoraria; American College of Radiology, Humboldt Independent Practice Association. Consultant; American College of Radiology. Advisory Board; American College of Radiology, Humboldt Independent Practice Association. Travel Expenses; American College of Radiology, Humboldt Independent Practice Association. Stock; Actimatech, Inc. Partnership; Actimatech, Inc. Executive committee, Secretary; American College of Radiology / CARROS. L. Iversen: owner/proprieter; Iversen Medical Billing. compensation from billings; Iversen Medical Billing. D.M. Macdonald: None.

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Actimatech, Inc: CEO: Partner; Crux Quality Solutions: Advisory Board Member: Advisory Board Member; St. Joseph Hospital: Join Y. Luh, MD: Independent Contractor

American College of Radiology: Honoraria, Travel Expenses; Humboldt Independent Practice Association: Advisory BoardAdvisory Board Member

Actimatech, Inc: Partnership, Stock

American Cancer Society: Greater Bay Area Redwood Region Board Member; American College of Radiology: Chair; American College of Radiology / CARROS: Executive committee, Secretary; Humboldt Del Norte County Medical Society: Secretary/Treasurer, Board member

Join Y. Luh, MD, FACP
Providence-St. Joseph Health
St. Joseph Hospital
2700 Dolbeer Street
Eureka, CA 95501
T: (707) 445-8121 x6548 F: (707) 269-3849

Oregon Health and Sciences University
3181 SW Sam Jackson Park Rd, KPV4
Portland, OR 97239


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TU_39_2979 - Submission of MIPS Quality Metrics via Claims in a Radiation Oncology Practice

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