MIPS: Advancing Care Information Category vs. Meaningful Use

Posted on  June 29, 2017

 

If you are a MIPS eligible clinician, then you will no longer be reporting for Meaningful Use. Instead, the Advancing Care Information category is the new program that exists in the MIPS track under the Quality Payment Program. The first thing you want to know about the Advancing Care Information Category for the MIPS performance year 2017 is that you have two measure set options that are based on the year your electronic health record was certified. Your two options are:

1. Advancing Care Information Objectives and Measures

2. 2017 Advancing Care Information Transition Objectives and Measures

So how do you choose which measure you report on? Option 1 is for eligible clinicians who have technology certified to the 2015 Edition or a combination of technologies from 2014 and 2015 editions that support those measures. Option 2 is for eligible clinicians that have technology certified to the 2015 edition or the 2014 edition or a combination of technologies from 2014 and 2015. Basically, if your EHR was certified in 2015, you will have a little more information to report than those who were certified in 2014. If you don’t know when your EHR was certified, you can find out by clicking this link and typing in the name of your vendor: https://chpl.healthit.gov/#/search

SCORING

The next thing that is interesting about this category of MIPS is that you can earn more points than what you’re allowed to use. The maximum score you can achieve is 155% but any score above 100% will be capped at 100%. CMS structured it this way to ensure that clinicians have the flexibility to focus on measures that are the most relevant to them and their practices. Here are the three ways in which you are scored for Advancing Care Information:

1. Required Base Score of 50%

2. Performance Score up to 90%

3. Bonus Score up to 15%

The performance and bonus score are added to the base score to get the total category score. Here’s an example of that calculation. Base + Performance + Bonus X .25 =?

Example: 50 + 60 + 1 = 111 points (capped at 100) | 100 x .25 = 25
You would earn 25 points added to the total composite performance score.

Now let’s talk about earning points in the Base Score. To receive the full 50%, you must submit yes for the Security risk analysis measure. For the rest of the measures, you must have at least 1 in the numerator for the numerator/denominator answers. Here are all the measures and example answers:

1. Security Risk Analysis (yes)
2. E-Prescribing (1/174)
3. Provide Patient Access (1/174)
4. Send a Summary of care (1/174)
5. Request/Accept Summary of care (1/174)

The above example would earn you the full 50% for the base score. However, the 2017 Advancing Care Information Transition measures are a bit different but work the same way. They are:

1. Security Risk Analysis (yes)
2. E-Prescribing (1/174)
3. Provide Patient Access (1/174)
4. Health Information Exchange (1/174)

The Performance Score is calculated slightly differently. You can earn a total of 90%. Most of the measures are worth 10% except for two measures reported under the 2017 Transition measures which are worth 20%. Your score is calculated based on your performance for each measure. For example: If you submit a numerator and denominator of 80/100 for the Patient-Specific Education measure, your performance rate would be 80%, and you would earn 8 out of 10 percentage points for that measure.

There is one measure under the Performance Score that is a yes/no answer and that is the Immunization Registry Reporting measure. If you submit a “yes,” then you will receive the full 10% for that measure.
Finally, let’s look at how the Bonus Score portion of the Advancing Care Information category is scored. There are two ways to earn bonus points. First, you can report to one or more additional public health and clinical data registries beyond the Immunization Registry Reporting measure and that will give you a 5% bonus. Secondly, you can report “yes” to completing one of the specified Improvement Activities using Certified EHR Technology (CEHRT) and you will earn a 10% bonus. There are approximately 18 Improvement Activities to choose from.

REWEIGHTING

What if you don’t use a certified EHR? If that’s the case, then you must meet a certain criterion in order to qualify for reweighting of the performance category to 0% so that it is not included in the total score. Simply not wanting to use a certified EHR is not sufficient enough to get reweighted. In order to apply for reweighting, you must meet one of the following:

1. Insufficient Internet Connectivity
2. Extreme and Uncontrollable Circumstances
3. Lack of Control over the Availability of CEHRT
4. The following MIPS eligible clinicians that qualify for automatic reweighting:

a. Hospital-based MIPS clinicians
b. Physician Assistants
c. Nurse Practitioners
d. Clinical Nurse Specialists
e. Certified Registered Nurse Anesthetists
f. Clinicians who lack face-to-face interactions with patients

Also, if No. 4 applies to you, CMS states you can still choose to report if you want to. If data is submitted, CMS will score your performance and weight your Advancing Care Information performance accordingly. If CMS approves your application for reweighting, they will reassign the weight from the Advancing Care Information category to the Quality category to maintain the potential for participants to earn up to 100 points in their final score.

Come back next time to learn about the Cost or Resource Use category. Though it won’t be measured for 2017 it will be in 2018 and we’re going to bet that you won’t be happy with our CMS plans to score this category. Especially when it will eventually become equal to the Quality category with regards to the weight of contribution on your overall score.

 
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