Making Sense of MACRA: MIPS Reporting Series, #1: Diabetic Eye Exam

Red dollar sign with a stethoscope around

As most of you know the Medicare Access and CHIP Reauthorization Act, a sweeping piece of legislation that changes the way healthcare providers are reimbursed for their services, was signed into law in April 2015.

One of the key provisions of this new law is the implementation of the Quality Payment Program, which rewards clinicians for value and outcomes in one of two ways: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

The majority of providers are eligible for reimbursement under MIPS, which adjusts payments based on how well physicians and healthcare groups perform in the following four categories:

Two categories, in particular — Quality and Promoting Interoperability — make up 75% of MIPS scores and are weighed based on physicians’ reporting systems and their reporting on distinct measure.

This makes it especially vital for medical practices and other healthcare organizations to have:

  1. an easy way to report on MIPS/MACRA and HEDIS performance measures, and
  2. a reporting system that promotes improvement of performance measures and overall scores.

Thanks to our recent push into the world of Care Coordination, Vital Interaction™ is making reporting these key measures as automated a process as possible so that our customers can do what they do best: focusing on and providing high-quality care to patients.

In this series of four posts, we are going to look at different examples of MIPS measures and show you how we can automate and improve your reporting workflows — or how to begin a new process all together.

While many of you may be able to report these measures on your existing EHR systems, the challenge lies in having a system that enables you to effortlessly connect with patients and directly improve the weight and scores of those measures.

That’s where our Care Coordination tool comes in.

Using this feature, you are able to not only report your measures, but also create automated campaigns to improve your numbers.

Let’s take a closer look at this tool and how you can use it to make sense of and improve upon your MACRA: MIPS score.

Navigating MACRA: MIPS Reporting

In this post, we’re going to use the diabetic eye exam measure as an example to explore how you can automate your reporting process.

The reporting requirements for Measure 117: Diabetes: Eye Exam are as follows:

“Percentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement period.”

Here’s how you can pull the info you need for reporting, step by step:

  1. With our existing integration to your EHR/EMR, we can filter the ages given. We begin our list with only patients 18-75 years of age.
  2. Now, we need to narrow down to only patients with diabetes. We use an ICD-10 integration to search for patients with the code E11 in past 2 years. You may choose a narrower range of diabetic patients if you wish.
  3. Next, we need to narrow the list down to patients who have had the eye exam. CPT codes 92002 through 92004, and CPT codes 92012 and 92014 cover that.
  4. We can even do an “or” and also look for all negative retinal exams in the last 12 months.

Now that you have your list, you can contact these patients using any communication method you want. You could even search further by provider or by zip code or by last visit.

Our system will then automatically email, text, and call these patients to schedule a visit.

On the other hand, you can use this tool to simply identify those patients who are due for a diabetic eye exam and coming in for other appointments. Good news! We can deliver that list to you, or even note it in the appointment record, to ensure the test is done — or at least scheduled before they leave.

By using this tool and automating the reporting process, you will not only improve your MIPS score but also providers’ relationships with patients by helping prevent complications.

In addition, you’ll enjoy the added bonus of being able to report higher numbers for bonuses.

We continually work to improve our list-building tools. Soon, we will have data visualization methods broken down by maps, charts, and graphs, which will make it much easier for you to assess and understand your patient population.

By taking advantage of our tools now, you are in a unique position to influence how our product will evolve and grow in the future — call us today at (512) 487-7625 to schedule a demo!

The Vital Interaction™ team works hard to stay in-the-know on regulatory changes as they relate to patient care, and put that information into action. Could your medical practice benefit from our services? Call (512) 487-7625 to find out more.

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