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What are some non-monetary statistics—besides labor hours and patient volume—that have a direct effect on the financial management of a health care organization?

March 20, 2023/in HEALTHCARE /by

Write a 175- to 265-word response in APA format to the following questions:

What are some non-monetary statistics—besides labor hours and patient volume—that have a direct effect on the financial management of a health care organization?
Are there statistics that do not translate into a monetary effect?

Please use sources listed below:

Gapenski, L. (2015). Healthcare finance: An introduction to accounting & financial management (sixth edition). Health Administration Press. ** Chapters 6 and 16 **

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The purpose of this assignment is to create an implementation plan for a strategic initiative.

March 20, 2023/in HEALTHCARE /by

The purpose of this assignment is to create an implementation plan for a strategic initiative.

A key part of every business plan is developing an implementation schedule that identifies all of the critical actions necessary for successful plan execution.

Create a timeline or chart that illustrates the implementation schedule for critical action steps necessary for successful execution of the strategic initiative.

The schedule should include the following:

Critical action steps necessary for implementation of the plan.
Identify the resources and competencies.
Describe how the resources and competencies are matched to the strategic initiative.
Identify how the action plan aligns to the organization’s strategic initiative

RUBRIC IS ATTACHED. PLEASE FOLLOW THIS FOR GRADING. should be very detailed

also attached previous two assignments that this will follow along with.

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Business Plan Implementation Schedule

March 20, 2023/in HEALTHCARE /by

Rubic_Print_Format

Course Code	Class Code	Assignment Title	Total Points
HCA-470	HCA-470-O101	Business Plan Part 4: Implementation Schedule	70.0
Criteria	Percentage	Unsatisfactory (0.00%)	Less Than Satisfactory (65.00%)	Satisfactory (75.00%)	Good (85.00%)	Excellent (100.00%)	Comments	Points Earned
Content	90.0%
Action Steps	30.0%	Critical action steps necessary for plan implementation are not included.	Critical action steps necessary for plan implementation are incomplete and/or incorrect.	Critical action steps necessary for plan implementation are minimal and lack clarity and details.	Critical action steps necessary for plan implementation are included, clear, and detailed.	Critical action steps necessary for plan implementation are thorough and expertly crafted.
Resources and Competencies	30.0%	Identification of resources and competencies and description of how each is matched to the strategic initiative is not included.	Identification of resources and competencies and description of how each is matched to the strategic initiative is incomplete and/or incorrect.	Identification of resources and competencies and description of how each is matched to the strategic initiative is included but lacks clarity and specificity.	Identification of resources and competencies and description of how each is matched to the strategic initiative is complete, clear, and specific.	Identification of resources and competencies and description of how each is matched to the strategic initiative is exemplary.
Action Plan Alignment	30.0%	Identification of how the action plan aligns to the organization’s strategic initiatives is not included.	Identification of how the action plan aligns to the organization’s strategic initiatives is incomplete and/or incorrect.	Identification of how the action plan aligns to the organization’s strategic initiatives is included but lacks explanation and supporting details.	Identification of how the action plan aligns to the organization’s strategic initiatives is complete and includes explanations and supporting details.	Identification of how the action plan aligns to the organization’s strategic initiatives is thorough and includes substantial supporting details.
Organization, Effectiveness, and Format	10.0%
Mechanics of Writing (includes spelling, punctuation, grammar, language use)	5.0%	Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.	Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.	Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.	Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.	Writer is clearly in command of standard, written, academic English.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)	5.0%	Sources are not documented.	Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.	Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.	Sources are documented, as appropriate to assignment and style, and format is mostly correct.	Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
Total Weightage	100% Order a Similar Paper

pure scientists

March 20, 2023/in HEALTHCARE /by

Week 1 Discussion 1

Historically, “pure scientists” have viewed qualitative research as inferior to quantitative research. What is your opinion on this position? Explain your answer.

wk 1 Discussion 2

What are three advantages and three disadvantages associated with conducting qualitative research? Discuss why they are considered advantages and disadvantages.

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Foundations of Qualitative Research Worksheet

March 20, 2023/in HEALTHCARE /by

RES/724 v6

Foundations of Qualitative Research Worksheet

RES/724 v6

Page 2 of 2

Week 1 Assign

Complete the Foundations of Qualitative Research Worksheet.

Foundations of Qualitative Research Worksheet

Exercise 1

The purpose of this exercise is to examine how philosophical assumptions differ and are exemplified (implicitly or explicitly) based on the interpretive framework selected.

1. Read the four articles listed below. Each qualitative journal article adopts a different interpretive lens.

Queer Theory	Adams et al. (2014). “Aren’t labels for pickle jars, not people?” Negotiating identity and community in talk about ‘being gay.’
Social Constructivist	Brown et al. (2006). Waiting for a liver transplant.
Postpositivist	Churchill et al. (2007). How rural low-income families have fun: A grounded theory study.
Transformative	Job et al. (2013). Toward better collaboration in the education of students with fetal alcohol spectrum disorders: Voices of teachers, administrators, caregivers, and allied professionals.

2. Complete the table below by providing detailed explanations and examples that demonstrate how the different philosophical assumptions are represented (implicitly or explicitly) in the selected journal articles.

		Ontological Assumptions	Epistemological Assumptions	Axiological Assumptions	Methodological Assumptions
Interpretive Frameworks	Queer Theory Adams et al. (2014)
	Social Constructivism Brown et al. (2006)
	Postpositivism Churchill et al. (2007)
	Transformative Job et al. (2013)

3. Discuss how the philosophical assumptions differed between the interpretive frameworks. Why is it important for researchers to understand the connection between philosophy and interpretive frameworks? Write your response in the space below.

Click or tap here to enter text.

Exercise 2

The purpose of this exercise is to explore the link between the research purpose and research questions.

Identify a potential research topic for a qualitative study. Write your topic in the space below.

Understanding the influence and the implications of staff wellbeing and health on residents in healthcare group home

Complete the table below by writing 1 or 2 research questions for an exploratory, descriptive, and explanatory study related to your selected topic. Include a justification that explains how your research question(s) align with and/or support the research purpose.

	Research Question(s)	Justification
Research Purpose	Exploratory
	Descriptive
	Explanatory

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Discuss the three phases of the development methodology as applied to the case project.

March 20, 2023/in HEALTHCARE /by

Requirements

Length: No maximum; minimum of five pages
Formatting: Double-spaced, 12-point, Times New Roman font with one-inch margins
File name: “ReflectionReport_YourLastName.docx”

Instructions

Throughout the course, you worked on a substantial systems development case project where you worked through the first three phases of structured systems development. In a professional essay format, concisely address the following:

Discuss the three phases of the development methodology as applied to the case project. The goal of this essay is to demonstrate your understanding of the covered systems analysis and design course topics and highlight your overall learning experience. (Structured DevelopmentLife Cycle three phases: 1 Planning 2 Analyze 3. Design)
For each phase, demonstrate your understanding by incorporating your own experiences with the case assignments into your analysis. Indicate any successes, challenges, or failures you experienced. Be specific.
Highlight the importance of each phase and the various approaches you applied to complete the overall design of your system. Within each phase, discuss the various approaches, models, diagrams, techniques, etc. used. Be sure to explain why each phase, tool, diagram, skill, and/or model was completed. If you feel any phase, tool, model, etc. was not required or was not important, be sure to highlight this in your analysis. Be sure to also include any figures, tools, models, milestone deliverables, etc. in an appendix and refer to them throughout your report. We had 10 milestones throughtout the course that I will attach
Be sure to include a “lessons learned” section where you discuss any lessons learned or take-aways from your case experience that you feel you will benefit from or apply in the future. Also discuss how you would improve the chance of implementing a successful project (approaches, teams, project management, etc.).
Be sure to include appropriate vocabulary and terminology to demonstrate your mastery of the HIMT 370 topic areas. Essays will be graded based on the application of materials as related to your own systems development project.
Your essay should be professionally written and formatted. The final essay should be something that you would be proud to share with prospective employers.
Essays must be completed individually.
Include the following sections/headings in the essay:
- Table of Contents
- Executive Summary
- Introduction
- Phase 1: [Enter title here]
- Phase 2: [Enter title here]
- Phase 3: [Enter title here]
- Lessons Learned
- Conclusion

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UWG-Pre Planning

March 20, 2023/in HEALTHCARE /by

HIMT-370 Y.White

UWG-Pre Planning

UWG Clinic

Task 1) – Business Profile

Create a business profile for UWG. In addition to the business profile, be sure to include an organization chart of UWG.

Org. Chart

Business Name: Universal Wellness Group (UWG)

Business Address: Brea, California

Customer Base: 8000 Patients from 325 Organizations

Total number of Employees: 26

Primary Line of Business: Preventive medicine and fitness

The Goals and Objectives

Our goal is to provide an environment that is concentrated on preventive health and fitness, as well as providing traditional medical and services.

The product

Internal Medicine office. Preventive health and fitness. Private practice.

The Target Market

Adults age ranging from 20 – geriatric.

Task 2) – Business Processes

Identify six business processes that UWG performs and explain who has primary responsibility for each process. Also describe what data is required and what information is generated by each process.

Process	Primary Owner	Data Required	Info Generated
Payroll	Corinne Summers	Hours worked, Vacation time taken, Amt staff make per hour	Salary, Tax computation, commission
Human resource	Fred Brown	Employee profile, Tenured, Salary, training, open and close positions	Pay Scale, Benefits, Job posting, Employee records
Appointments	Lisa Sung	Scheduling Data, Providers available	Appointment desk schedule
Medical Records Clerk	Susan Gifford	PT encounters and information	Proper Treatment plans for PT proper billing
Billing Insurance companies	Tammy Allpio	Proper coding of charges, correct insurance information	Generate claim to send to payor
Monitor money being received and spent	Tom Capaletti	Visits being billed, visits paid, expenses and invoices	Expenses reports, budgets, loss reports

Task 3) Opportunities

UWG has a variety of information systems they could adopt. Why would UWG implement a transaction processing system, a business support system, or an ERP system?

Transaction processing system can simplify charges and insurance claims. Business support system can be utilized for analyzing claims, payments, and workload. A user productivity system increases overall efficiency within the office.

Recommendation

What information system would you recommend UWG to implement?

I would recommend UWG utilize a transaction processing system. This will allow each charge, payment and insurance claim to be completely tracked. It would also reduce administrative costs. Although not a large clinic, jobs perhaps could be combined. This system also has the capability of speeding up insurance reimbursements and provide thorough reports. The system would start with the correct information being gather during scheduling.

Task 4) – Development Methodology

Briefly introduce the three systems development methods discussed in the chapter. Select one approach and explain the strengths and weaknesses of using your selected method.

Transaction Processing System (TPS) is an operating system used to process day to day recurring business transactions, such as customer billing. A business Support System (BSS) provides job related information support to users at all levels of a company. Although the business support system could be utilized to determine future staffing needs, it is very limiting regarding day to day processes. Enterprise Resource Planning (ERP) is a process that establishes an enterprise wide strategy for IT resources. ERP dents a specific architecture, including standards for data, processing network and user interface design.

A business support system (BSS) is an information system that is used to support various end-to-end telecommunication services, such as Billing, order management, and customer relationship management. I have listed the pros and cons of working with a BSS system.

Pros:

Offers a paperless method of exchange

Bother free access, ensuring the bill with the assistance of secret key and can be opened just by the beneficiary.

Allows working from home

Reduce central office costs

Better use of time

Cons:

Billing frame works can be outsourced

Security breaches and poor working conditions, the dread of security to the individual’s data, expanded spyware and malware on the web.

Lack of community. When a business’s workforce is widely scattered, the sense of community and business culture can be greatly reduced or completely disappear.

Timothy Jones

Deloris Garcia Physicians

Anita Davenport Office Manager

Susan Gifford

Medical Records

Tom Capaletti

Accounts Receivables

Fred Brown

HR/Employee Benefits

Connie Summers

Payroll

Tammy Alipio

Billing

Lisa Sung

Appointments Clerk

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Historical MIPS Quality Measure Benchmark

March 20, 2023/in HEALTHCARE /by

Table 2: Historical MIPS Quality Measure Benchmark Results; created using PY2017 data and PY2019 Eligibility Rules
Measure_Name	Measure_ID	Collection_Type	Measure_Type	Benchmark	Standard_Deviation	Average	Decile_3	Decile_4	Decile_5	Decile_6	Decile_7	Decile_8	Decile_9	Decile_10	TOPPED_OUT	SevenPointCap
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)	1	eCQM	Intermediate Outcome	Y	28.2	46.3	77.14 – 60.79	60.78 – 48.49	48.48 – 38.90	38.89 – 31.60	31.59 – 25.88	25.87 – 20.56	20.55 – 14.72	<= 14.71	No	No
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)	1	Medicare Part B Claims	Intermediate Outcome	Y	24.5	24.6	44.44 – 29.04	29.03 – 19.52	19.51 – 14.72	14.71 – 11.12	11.11 – 8.34	8.33 – 5.57	5.56 – 2.79	<= 2.78	No	No
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)	1	MIPS CQM	Intermediate Outcome	Y	30.1	36.5	68.31 – 50.63	50.62 – 37.51	37.50 – 28.70	28.69 – 20.01	20.00 – 13.60	13.59 – 9.03	9.02 – 2.71	<= 2.70	No	No
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)	5	eCQM	Process	Y	13.8	82.8	74.19 – 78.56	78.57 – 82.13	82.14 – 85.18	85.19 – 87.92	87.93 – 90.90	90.91 – 93.74	93.75 – 97.72	>= 97.73	No	No
Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)	5	MIPS CQM	Process	Y	13.5	94.1	93.33 – 96.96	96.97 – 98.40	98.41 – 99.99	—	—	—	—	100	Yes	No
Coronary Artery Disease (CAD): Antiplatelet Therapy	6	MIPS CQM	Process	Y	13.2	89.6	84.13 – 87.99	88.00 – 90.66	90.67 – 92.85	92.86 – 95.09	95.10 – 97.08	97.09 – 99.99	—	100	No	No
Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%)	7	eCQM	Process	Y	13.7	82.9	76.74 – 80.30	80.31 – 83.17	83.18 – 85.28	85.29 – 87.15	87.16 – 89.73	89.74 – 91.91	91.92 – 94.86	>= 94.87	No	No
Coronary Artery Disease (CAD): Beta-Blocker Therapy – Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%)	7	MIPS CQM	Process	Y	8.8	96.3	96.17 – 98.11	98.12 – 99.76	99.77 – 99.99	—	—	—	—	100	Yes	No
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)	8	eCQM	Process	Y	11.1	87.9	80.49 – 85.61	85.62 – 88.97	88.98 – 91.29	91.30 – 93.04	93.05 – 94.73	94.74 – 96.34	96.35 – 99.99	100	No	No
Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)	8	MIPS CQM	Process	Y	10.3	95.9	95.45 – 98.05	98.06 – 99.28	99.29 – 99.99	—	—	—	—	100	Yes	No
Anti-Depressant Medication Management	9	eCQM	Process	Y	32.4	53.9	16.67 – 31.06	31.07 – 42.18	42.19 – 53.15	53.16 – 71.73	71.74 – 82.78	82.79 – 88.88	88.89 – 94.43	>= 94.44	No	No
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation	12	eCQM	Process	Y	20	86.2	79.11 – 86.57	86.58 – 90.61	90.62 – 93.87	93.88 – 96.31	96.32 – 98.01	98.02 – 99.10	99.11 – 99.99	100	No	No
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation	12	Medicare Part B Claims	Process	Y	9.8	97.4	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation	12	MIPS CQM	Process	Y	9.8	96.2	96.47 – 99.16	99.17 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Age-Related Macular Degeneration (AMD): Dilated Macular Examination	14	Medicare Part B Claims	Process	Y	10.2	97.8	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Age-Related Macular Degeneration (AMD): Dilated Macular Examination	14	MIPS CQM	Process	Y	24.3	86.2	76.54 – 89.80	89.81 – 96.53	96.54 – 99.70	99.71 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care	19	eCQM	Process	Y	28.8	61.7	33.90 – 47.61	47.62 – 57.88	57.89 – 67.02	67.03 – 75.36	75.37 – 82.48	82.49 – 90.02	90.03 – 95.99	>= 96.00	No	No
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care	19	Medicare Part B Claims	Process	Y	8.6	98.2	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care	19	MIPS CQM	Process	Y	26.6	83.4	70.29 – 84.41	84.42 – 92.72	92.73 – 98.56	98.57 – 99.99	—	—	—	100	Yes	No
Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin	21	Medicare Part B Claims	Process	Y	22.6	92	99.17 – 99.99	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Perioperative Care: Selection of Prophylactic Antibiotic – First OR Second Generation Cephalosporin	21	MIPS CQM	Process	Y	17.5	94.6	98.67 – 99.99	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)	23	Medicare Part B Claims	Process	Y	19.9	94.9	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)	23	MIPS CQM	Process	Y	17.4	95	98.68 – 99.99	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Communication with the Physician or Other Clinician Managing On-going Care Post-Fracture for Men and Women Aged 50 Years and Older	24	Medicare Part B Claims	Process	Y	31.9	76.3	32.35 – 63.63	63.64 – 92.30	92.31 – 96.20	96.21 – 97.61	97.62 – 99.99	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Communication with the Physician or Other Clinician Managing On-going Care Post-Fracture for Men and Women Aged 50 Years and Older	24	MIPS CQM	Process	Y	32.4	59.6	26.32 – 45.09	45.10 – 55.31	55.32 – 60.20	60.21 – 69.99	70.00 – 80.55	80.56 – 99.99	—	100	No	No
Screening for Osteoporosis for Women Aged 65-85 Years of Age	39	Medicare Part B Claims	Process	Y	26.5	56.2	32.79 – 42.36	42.37 – 49.00	49.01 – 55.90	55.91 – 62.54	62.55 – 70.68	70.69 – 82.88	82.89 – 95.49	>= 95.50	No	No
Screening for Osteoporosis for Women Aged 65-85 Years of Age	39	MIPS CQM	Process	Y	31	46.2	11.38 – 22.43	22.44 – 34.71	34.72 – 45.25	45.26 – 58.10	58.11 – 67.97	67.98 – 78.45	78.46 – 88.23	>= 88.24	No	No
Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery	44	MIPS CQM	Process	Y	14.7	92.7	90.35 – 95.89	95.90 – 97.38	97.39 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Medication Reconciliation Post-Discharge	46	Medicare Part B Claims	Process	Y	16.3	94.2	95.74 – 98.40	98.41 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Medication Reconciliation Post-Discharge	46	MIPS CQM	Process	Y	17.2	93.3	94.24 – 97.62	97.63 – 99.92	99.93 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Care Plan	47	Medicare Part B Claims	Process	Y	33.1	78.4	50.32 – 82.60	82.61 – 92.88	92.89 – 97.45	97.46 – 99.30	99.31 – 99.99	—	—	100	Yes	No
Care Plan	47	MIPS CQM	Process	Y	35.9	66.1	24.33 – 45.01	45.02 – 65.74	65.75 – 82.16	82.17 – 91.89	91.90 – 97.31	97.32 – 99.71	99.72 – 99.99	100	No	No
Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older	48	Medicare Part B Claims	Process	Y	43.1	65	3.88 – 13.85	13.86 – 72.40	72.41 – 96.68	96.69 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older	48	MIPS CQM	Process	Y	37.5	59.8	12.22 – 31.74	31.75 – 52.36	52.37 – 70.44	70.45 – 84.26	84.27 – 95.10	95.11 – 99.50	99.51 – 99.99	100	No	No
Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older	50	Medicare Part B Claims	Process	Y	18.2	94.4	97.30 – 98.87	98.88 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older	50	MIPS CQM	Process	Y	26.6	71.4	47.22 – 59.99	60.00 – 68.98	68.99 – 75.63	75.64 – 85.49	85.50 – 92.58	92.59 – 99.65	99.66 – 99.99	100	No	No
Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation	51	Medicare Part B Claims	Process	Y	33.7	77	38.10 – 77.26	77.27 – 92.44	92.45 – 98.75	98.76 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Chronic Obstructive Pulmonary Disease (COPD): Spirometry Evaluation	51	MIPS CQM	Process	Y	33.4	64.9	25.00 – 45.44	45.45 – 60.42	60.43 – 75.75	75.76 – 86.45	86.46 – 93.82	93.83 – 99.35	99.36 – 99.99	100	No	No
Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy	52	Medicare Part B Claims	Process	Y	21.9	89.9	90.14 – 98.14	98.15 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy	52	MIPS CQM	Process	Y	13.4	93.1	90.16 – 95.21	95.22 – 96.48	96.49 – 98.85	98.86 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Appropriate Treatment for Children with Upper Respiratory Infection (URI)	65	eCQM	Process	Y	15.8	88.1	80.95 – 88.36	88.37 – 91.76	91.77 – 93.87	93.88 – 95.60	95.61 – 96.87	96.88 – 98.21	98.22 – 99.99	100	No	No
Appropriate Treatment for Children with Upper Respiratory Infection (URI)	65	MIPS CQM	Process	Y	13.9	93.2	91.49 – 95.01	95.02 – 97.02	97.03 – 97.84	97.85 – 98.69	98.70 – 99.19	99.20 – 99.74	99.75 – 99.99	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Appropriate Testing for Children with Pharyngitis	66	eCQM	Process	Y	29.6	66.7	36.71 – 60.04	60.05 – 72.40	72.41 – 78.37	78.38 – 83.32	83.33 – 87.62	87.63 – 91.42	91.43 – 94.58	>= 94.59	No	No
Appropriate Testing for Children with Pharyngitis	66	MIPS CQM	Process	Y	17.5	77.4	64.57 – 69.60	69.61 – 75.41	75.42 – 81.74	81.75 – 85.50	85.51 – 87.95	87.96 – 91.77	91.78 – 97.54	>= 97.55	No	No
Hematology: Myelodysplastic Syndrome (MDS) and Acute Leukemias: Baseline Cytogenetic Testing Performed on Bone Marrow	67	MIPS CQM	Process	Y	38.1	42.9	8.00 – 12.49	12.50 – 22.72	22.73 – 28.52	28.53 – 34.61	34.62 – 78.78	78.79 – 99.99	—	100	No	No
Hematology: Myelodysplastic Syndrome (MDS): Documentation of Iron Stores in Patients Receiving Erythropoietin Therapy	68	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Hematology: Multiple Myeloma: Treatment with Bisphosphonates	69	MIPS CQM	Process	Y	21.1	61.5	42.86 – 47.49	47.50 – 64.51	64.52 – 66.66	66.67 – 71.42	71.43 – 71.87	71.88 – 76.91	76.92 – 92.30	>= 92.31	No	No
Hematology: Chronic Lymphocytic Leukemia (CLL): Baseline Flow Cytometry	70	MIPS CQM	Process	Y	36.5	53.1	16.67 – 23.20	23.21 – 32.25	32.26 – 35.94	35.95 – 67.85	67.86 – 95.44	95.45 – 99.99	—	100	No	No
Prevention of Central Venous Catheter (CVC) – Related Bloodstream Infections	76	Medicare Part B Claims	Process	Y	17.3	93.7	95.24 – 98.60	98.61 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Prevention of Central Venous Catheter (CVC) – Related Bloodstream Infections	76	MIPS CQM	Process	Y	15.7	94.2	95.67 – 99.08	99.09 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Acute Otitis Externa (AOE): Topical Therapy	91	Medicare Part B Claims	Process	Y	32.6	78.5	43.36 – 86.60	86.61 – 93.21	93.22 – 99.65	99.66 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Acute Otitis Externa (AOE): Topical Therapy	91	MIPS CQM	Process	Y	20	83.2	67.34 – 78.76	78.77 – 86.33	86.34 – 91.32	91.33 – 95.23	95.24 – 97.36	97.37 – 99.99	—	100	No	No
Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use	93	Medicare Part B Claims	Process	Y	21.6	88.7	89.12 – 93.50	93.51 – 96.35	96.36 – 97.82	97.83 – 99.92	99.93 – 99.99	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use	93	MIPS CQM	Process	Y	23.7	80.1	63.16 – 77.35	77.36 – 83.96	83.97 – 89.65	89.66 – 93.32	93.33 – 96.14	96.15 – 99.99	—	100	No	No
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients	102	eCQM	Process	Y	29.8	78.3	59.34 – 75.73	75.74 – 83.90	83.91 – 91.99	92.00 – 98.30	98.31 – 99.99	—	—	100	No	No
Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients	102	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Prostate Cancer: Combination Androgen Deprivation Therapy for High Risk or Very High Risk Prostate Cancer	104	MIPS CQM	Process	Y	30.6	69	39.65 – 48.16	48.17 – 55.05	55.06 – 76.22	76.23 – 93.25	93.26 – 99.59	99.60 – 99.99	—	100	No	No
Adult Major Depressive Disorder (MDD): Suicide Risk Assessment	107	eCQM	Process	Y	36	33.9	1.51 – 3.56	3.57 – 8.10	8.11 – 17.48	17.49 – 30.28	30.29 – 54.72	54.73 – 77.56	77.57 – 96.66	>= 96.67	No	No
Osteoarthritis (OA): Function and Pain Assessment	109	Medicare Part B Claims	Process	Y	22.9	89.2	87.28 – 95.71	95.72 – 98.71	98.72 – 99.88	99.89 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Osteoarthritis (OA): Function and Pain Assessment	109	MIPS CQM	Process	Y	35	73.7	34.62 – 63.00	63.01 – 86.63	86.64 – 94.37	94.38 – 99.99	—	—	—	100	No	No
Preventive Care and Screening: Influenza Immunization	110	eCQM	Process	Y	28.1	42	15.50 – 23.63	23.64 – 31.20	31.21 – 38.65	38.66 – 46.76	46.77 – 56.01	56.02 – 67.49	67.50 – 84.98	>= 84.99	No	No
Preventive Care and Screening: Influenza Immunization	110	Medicare Part B Claims	Process	Y	32.3	64.2	29.52 – 41.41	41.42 – 56.31	56.32 – 71.18	71.19 – 82.88	82.89 – 94.14	94.15 – 99.41	99.42 – 99.99	100	No	No
Preventive Care and Screening: Influenza Immunization	110	MIPS CQM	Process	Y	31.4	61.8	29.85 – 41.42	41.43 – 53.84	53.85 – 66.02	66.03 – 76.93	76.94 – 87.80	87.81 – 96.40	96.41 – 99.99	100	No	No
Pneumococcal Vaccination Status for Older Adults	111	eCQM	Process	Y	30.1	50.8	19.01 – 31.06	31.07 – 42.70	42.71 – 53.43	53.44 – 62.85	62.86 – 71.81	71.82 – 80.42	80.43 – 90.40	>= 90.41	No	No
Pneumococcal Vaccination Status for Older Adults	111	Medicare Part B Claims	Process	Y	24.8	71.6	49.76 – 61.10	61.11 – 70.10	70.11 – 77.31	77.32 – 82.95	82.96 – 89.43	89.44 – 95.66	95.67 – 99.99	100	No	No
Pneumococcal Vaccination Status for Older Adults	111	MIPS CQM	Process	Y	28.4	58.4	30.23 – 44.52	44.53 – 55.55	55.56 – 63.63	63.64 – 70.42	70.43 – 76.37	76.38 – 83.76	83.77 – 95.44	>= 95.45	No	No
Breast Cancer Screening	112	eCQM	Process	Y	26.7	48.4	22.28 – 32.74	32.75 – 42.31	42.32 – 51.05	51.06 – 58.43	58.44 – 65.67	65.68 – 73.43	73.44 – 82.30	>= 82.31	No	No
Breast Cancer Screening	112	Medicare Part B Claims	Process	Y	24.7	64.6	44.44 – 52.07	52.08 – 58.44	58.45 – 64.28	64.29 – 70.96	70.97 – 79.84	79.85 – 90.23	90.24 – 99.99	100	No	No
Breast Cancer Screening	112	MIPS CQM	Process	Y	29.3	62.9	35.99 – 48.25	48.26 – 57.57	57.58 – 67.38	67.39 – 75.24	75.25 – 85.30	85.31 – 93.44	93.45 – 99.99	100	No	No
Colorectal Cancer Screening	113	eCQM	Process	Y	28.9	44.4	13.49 – 24.00	24.01 – 33.96	33.97 – 44.38	44.39 – 54.79	54.80 – 64.00	64.01 – 73.37	73.38 – 83.50	>= 83.51	No	No
Colorectal Cancer Screening	113	Medicare Part B Claims	Process	Y	28.9	66.3	36.60 – 50.99	51.00 – 62.49	62.50 – 71.22	71.23 – 79.99	80.00 – 88.63	88.64 – 97.72	97.73 – 99.99	100	No	No
Colorectal Cancer Screening	113	MIPS CQM	Process	Y	30.4	65.3	35.90 – 49.50	49.51 – 60.82	60.83 – 70.87	70.88 – 80.61	80.62 – 90.40	90.41 – 96.97	96.98 – 99.99	100	No	No
Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis	116	MIPS CQM	Process	Y	27.8	72.6	44.27 – 57.07	57.08 – 72.02	72.03 – 83.77	83.78 – 90.98	90.99 – 95.56	95.57 – 97.54	97.55 – 99.99	100	No	No
Diabetes: Eye Exam	117	eCQM	Process	Y	35.8	60.7	20.61 – 31.99	32.00 – 45.52	45.53 – 66.01	66.02 – 89.11	89.12 – 95.64	95.65 – 98.25	98.26 – 99.72	>= 99.73	No	No
Diabetes: Eye Exam	117	Medicare Part B Claims	Process	Y	24.9	86.9	72.00 – 96.87	96.88 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Diabetes: Eye Exam	117	MIPS CQM	Process	Y	24.7	85.8	77.26 – 89.99	90.00 – 95.81	95.82 – 98.48	98.49 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy – Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)	118	MIPS CQM	Process	Y	11.1	83.3	76.00 – 78.56	78.57 – 81.07	81.08 – 83.90	83.91 – 86.35	86.36 – 88.72	88.73 – 92.25	92.26 – 98.17	>= 98.18	No	No
Diabetes: Medical Attention for Nephropathy	119	eCQM	Process	Y	19.7	79	67.86 – 74.79	74.80 – 79.99	80.00 – 84.13	84.14 – 87.73	87.74 – 91.10	91.11 – 94.62	94.63 – 98.38	>= 98.39	No	No
Diabetes: Medical Attention for Nephropathy	119	MIPS CQM	Process	Y	20.1	85.1	74.38 – 82.85	82.86 – 87.70	87.71 – 91.93	91.94 – 97.23	97.24 – 99.99	—	—	100	No	No
Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy – Neurological Evaluation	126	MIPS CQM	Process	Y	29.3	82.5	66.15 – 85.22	85.23 – 96.42	96.43 – 99.99	—	—	—	—	100	Yes	No
Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention – Evaluation of Footwear	127	MIPS CQM	Process	Y	27.9	84.8	70.59 – 92.85	92.86 – 99.45	99.46 – 99.99	—	—	—	—	100	Yes	No
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	128	eCQM	Process	Y	28.5	45.4	21.15 – 24.58	24.59 – 28.51	28.52 – 34.20	34.21 – 43.84	43.85 – 60.30	60.31 – 78.24	78.25 – 93.28	>= 93.29	No	No
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	128	Medicare Part B Claims	Process	Y	30.3	74.2	37.52 – 47.77	47.78 – 74.47	74.48 – 95.19	95.20 – 99.26	99.27 – 99.99	—	—	100	Yes	No
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan	128	MIPS CQM	Process	Y	31.8	72.6	34.35 – 54.25	54.26 – 74.56	74.57 – 90.59	90.60 – 97.55	97.56 – 99.86	99.87 – 99.99	—	100	No	No
Documentation of Current Medications in the Medical Record	130	eCQM	Process	Y	18.5	90.3	87.55 – 93.48	93.49 – 96.28	96.29 – 97.98	97.99 – 98.99	99.00 – 99.57	99.58 – 99.88	99.89 – 99.99	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Documentation of Current Medications in the Medical Record	130	Medicare Part B Claims	Process	Y	13.1	96.1	97.95 – 99.51	99.52 – 99.91	99.92 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Documentation of Current Medications in the Medical Record	130	MIPS CQM	Process	Y	30.5	82.6	68.06 – 90.27	90.28 – 97.23	97.24 – 99.50	99.51 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Pain Assessment and Follow-Up	131	Medicare Part B Claims	Process	Y	25	87.9	80.57 – 96.91	96.92 – 99.63	99.64 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Pain Assessment and Follow-Up	131	MIPS CQM	Process	Y	38.2	65.1	15.80 – 39.99	40.00 – 62.78	62.79 – 84.05	84.06 – 95.25	95.26 – 99.54	99.55 – 99.99	—	100	No	No
Preventive Care and Screening: Screening for Depression and Follow-Up Plan	134	eCQM	Process	Y	32.2	37.1	4.88 – 10.17	10.18 – 17.59	17.60 – 28.28	28.29 – 42.29	42.30 – 56.82	56.83 – 73.29	73.30 – 87.49	>= 87.50	No	No
Preventive Care and Screening: Screening for Depression and Follow-Up Plan	134	Medicare Part B Claims	Process	Y	39.6	69.3	12.94 – 53.91	53.92 – 80.22	80.23 – 96.98	96.99 – 99.99	—	—	—	100	Yes	No
Preventive Care and Screening: Screening for Depression and Follow-Up Plan	134	MIPS CQM	Process	Y	38.5	67.7	17.11 – 45.64	45.65 – 73.81	73.82 – 90.05	90.06 – 98.49	98.50 – 99.99	—	—	100	No	No
Melanoma: Continuity of Care – Recall System	137	MIPS CQM	Structure	Y	23	88.6	83.83 – 94.33	94.34 – 98.79	98.80 – 99.99	—	—	—	—	100	No	No
Melanoma: Coordination of Care	138	MIPS CQM	Process	Y	30.2	75.8	49.44 – 63.63	63.64 – 78.25	78.26 – 92.58	92.59 – 99.99	—	—	—	100	No	No
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care	141	Medicare Part B Claims	Outcome	Y	10.8	97.6	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% OR Documentation of a Plan of Care	141	MIPS CQM	Outcome	Y	26.4	84.8	73.85 – 87.49	87.50 – 96.29	96.30 – 99.30	99.31 – 99.99	—	—	—	100	No	No
Oncology: Medical and Radiation – Pain Intensity Quantified	143	eCQM	Process	Y	25.4	84.9	77.21 – 87.78	87.79 – 94.91	94.92 – 97.26	97.27 – 98.34	98.35 – 99.45	99.46 – 99.99	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Oncology: Medical and Radiation – Pain Intensity Quantified	143	MIPS CQM	Process	Y	17.1	91.9	90.31 – 95.39	95.40 – 97.12	97.13 – 98.56	98.57 – 99.25	99.26 – 99.99	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Oncology: Medical and Radiation – Plan of Care for Pain	144	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Radiology: Exposure Dose or Time Reported for Procedures Using Fluoroscopy	145	Medicare Part B Claims	Process	Y	26.5	81.9	66.41 – 82.92	82.93 – 90.90	90.91 – 95.17	95.18 – 97.39	97.40 – 99.06	99.07 – 99.99	—	100	Yes	No
Radiology: Exposure Dose or Time Reported for Procedures Using Fluoroscopy	145	MIPS CQM	Process	Y	24.9	85.1	73.10 – 88.03	88.04 – 94.91	94.92 – 98.15	98.16 – 99.53	99.54 – 99.99	—	—	100	Yes	No
Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Screening Mammograms	146	Medicare Part B Claims	Process	Y	1.2	0.3	0.23 – 0.01	—	—	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Radiology: Inappropriate Use of “Probably Benign” Assessment Category in Screening Mammograms	146	MIPS CQM	Process	Y	3.5	0.5	0.24 – 0.12	0.11 – 0.05	0.04 – 0.01	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy	147	Medicare Part B Claims	Process	Y	22.3	86.2	76.47 – 87.17	87.18 – 94.05	94.06 – 97.00	97.01 – 99.99	—	—	—	100	Yes	No
Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy	147	MIPS CQM	Process	Y	13.7	94.1	93.04 – 97.96	97.97 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Falls: Risk Assessment	154	Medicare Part B Claims	Process	Y	18.3	94	96.95 – 99.99	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Falls: Risk Assessment	154	MIPS CQM	Process	Y	35.4	73.2	28.63 – 60.81	60.82 – 84.99	85.00 – 95.96	95.97 – 99.73	99.74 – 99.99	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Falls: Plan of Care	155	Medicare Part B Claims	Process	Y	30.8	81.4	55.81 – 84.61	84.62 – 99.20	99.21 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Falls: Plan of Care	155	MIPS CQM	Process	Y	28.8	82.7	67.86 – 86.78	86.79 – 94.99	95.00 – 98.21	98.22 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) Prophylaxis	160	eCQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Coronary Artery Bypass Graft (CABG): Prolonged Intubation	164	MIPS CQM	Outcome	Y	5.9	7.6	11.40 – 9.10	9.09 – 7.70	7.69 – 6.81	6.80 – 5.56	5.55 – 4.29	4.28 – 3.09	3.08 – 1.55	<= 1.54	No	No
Coronary Artery Bypass Graft (CABG): Deep Sternal Wound Infection Rate	165	MIPS CQM	Outcome	Y	1.1	0.5	0.84 – 0.01	—	—	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Coronary Artery Bypass Graft (CABG): Stroke	166	MIPS CQM	Outcome	Y	1.6	1.3	2.38 – 1.80	1.79 – 1.27	1.26 – 0.72	0.71 – 0.01	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Coronary Artery Bypass Graft (CABG): Postoperative Renal Failure	167	MIPS CQM	Outcome	Y	2.6	2.2	3.51 – 2.71	2.70 – 2.16	2.15 – 1.86	1.85 – 1.29	1.28 – 0.89	0.88 – 0.01	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Coronary Artery Bypass Graft (CABG): Surgical Re-Exploration	168	MIPS CQM	Outcome	Y	2.6	2.4	3.95 – 3.14	3.13 – 2.64	2.63 – 1.80	1.79 – 1.28	1.27 – 0.88	0.87 – 0.01	—	0	Yes	No
Rheumatoid Arthritis (RA): Tuberculosis Screening	176	MIPS CQM	Process	Y	31	65.4	32.00 – 48.14	48.15 – 55.55	55.56 – 68.00	68.01 – 80.42	80.43 – 99.03	99.04 – 99.99	—	100	No	No
Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity	177	MIPS CQM	Process	Y	29.4	79	57.23 – 74.99	75.00 – 88.23	88.24 – 96.01	96.02 – 99.99	—	—	—	100	Yes	No
Rheumatoid Arthritis (RA): Functional Status Assessment	178	MIPS CQM	Process	Y	27.2	82	67.61 – 81.39	81.40 – 90.58	90.59 – 95.94	95.95 – 99.99	—	—	—	100	Yes	No
Rheumatoid Arthritis (RA): Assessment and Classification of Disease Prognosis	179	MIPS CQM	Process	Y	30.9	76.7	44.53 – 67.88	67.89 – 85.30	85.31 – 95.21	95.22 – 99.99	—	—	—	100	Yes	No
Rheumatoid Arthritis (RA): Glucocorticoid Management	180	MIPS CQM	Process	Y	28.6	79.3	52.68 – 75.78	75.79 – 87.95	87.96 – 95.05	95.06 – 99.57	99.58 – 99.99	—	—	100	Yes	No
Elder Maltreatment Screen and Follow-Up Plan	181	Medicare Part B Claims	Process	Y	34.6	80.9	55.38 – 97.31	97.32 – 99.55	99.56 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Elder Maltreatment Screen and Follow-Up Plan	181	MIPS CQM	Process	Y	29.9	75.6	50.65 – 66.03	66.04 – 77.77	77.78 – 89.28	89.29 – 96.78	96.79 – 99.99	—	—	100	No	No
Functional Outcome Assessment	182	Medicare Part B Claims	Process	Y	14.7	96.7	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Functional Outcome Assessment	182	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use	185	Medicare Part B Claims	Process	Y	8.5	97.8	98.57 – 99.99	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use	185	MIPS CQM	Process	Y	25.8	82	61.64 – 84.99	85.00 – 90.53	90.54 – 95.41	95.42 – 98.40	98.41 – 99.99	—	—	100	Yes	No
Stroke and Stroke Rehabilitation: Thrombolytic Therapy	187	MIPS CQM	Process	Y	20.5	90.1	88.89 – 96.48	96.49 – 99.99	—	—	—	—	—	100	Yes	No
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery	191	eCQM	Outcome	Y	18.4	88.5	85.25 – 90.62	90.63 – 93.40	93.41 – 95.58	95.59 – 96.87	96.88 – 97.82	97.83 – 98.77	98.78 – 99.99	100	No	No
Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery	191	MIPS CQM	Outcome	Y	9.3	96.1	94.37 – 96.87	96.88 – 98.97	98.98 – 99.99	—	—	—	—	100	Yes	No
Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures	192	eCQM	Outcome	Y	0.9	0.2	—	—	—	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures	192	MIPS CQM	Outcome	Y	6.5	0.9	—	—	—	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Radiology: Stenosis Measurement in Carotid Imaging Reports	195	Medicare Part B Claims	Process	Y	16.1	92.7	91.72 – 96.22	96.23 – 98.17	98.18 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Radiology: Stenosis Measurement in Carotid Imaging Reports	195	MIPS CQM	Process	Y	10.7	96.6	97.81 – 99.84	99.85 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
HIV/AIDS: Sexually Transmitted Disease Screening for Chlamydia, Gonorrhea, and Syphilis	205	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Functional Status Change for Patients with Knee Impairments	217	MIPS CQM	Patient Reported Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Functional Status Change for Patients with Hip Impairments	218	MIPS CQM	Patient Reported Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Functional Status Change for Patients with Foot or Ankle Impairments	219	MIPS CQM	Patient Reported Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Functional Status Change for Patients with Lumbar Impairments	220	MIPS CQM	Patient Reported Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Functional Status Change for Patients with Shoulder Impairments	221	MIPS CQM	Patient Reported Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Functional Status Change for Patients with Elbow, Wrist or Hand Impairments	222	MIPS CQM	Patient Reported Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Functional Status Change for Patients with Other General Orthopaedic Impairments	223	MIPS CQM	Patient Reported Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Radiology: Reminder System for Screening Mammograms	225	Medicare Part B Claims	Structure	Y	19.3	94.3	99.36 – 99.99	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Radiology: Reminder System for Screening Mammograms	225	MIPS CQM	Structure	Y	13.8	97.4	—	—	—	—	—	—	—	100	Yes	No
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	226	Medicare Part B Claims	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	226	eCQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention	226	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Controlling High Blood Pressure	236	eCQM	Intermediate Outcome	Y	16.6	63	51.46 – 56.82	56.83 – 60.94	60.95 – 64.67	64.68 – 68.17	68.18 – 72.00	72.01 – 76.25	76.26 – 82.20	>= 82.21	No	No
Controlling High Blood Pressure	236	Medicare Part B Claims	Intermediate Outcome	Y	18.6	72.2	58.57 – 63.97	63.98 – 68.82	68.83 – 73.90	73.91 – 78.56	78.57 – 83.32	83.33 – 88.31	88.32 – 94.88	>= 94.89	No	No
Controlling High Blood Pressure	236	MIPS CQM	Intermediate Outcome	Y	24.1	69.3	52.41 – 60.04	60.05 – 65.67	65.68 – 70.61	70.62 – 76.82	76.83 – 84.61	84.62 – 93.39	93.40 – 99.99	100	No	No
Use of High-Risk Medications in the Elderly	238	eCQM	Process	Y	9	4.7	8.04 – 4.75	4.74 – 2.68	2.67 – 1.32	1.31 – 0.54	0.53 – 0.05	0.04 – 0.01	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Use of High-Risk Medications in the Elderly	238	MIPS CQM	Process	Y	6.6	1.7	0.68 – 0.29	0.28 – 0.14	0.13 – 0.01	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents	239	eCQM	Process	Y	19.9	37.6	26.23 – 29.51	29.52 – 31.47	31.48 – 32.79	32.80 – 33.85	33.86 – 38.72	38.73 – 47.76	47.77 – 65.52	>= 65.53	No	No
Childhood Immunization Status	240	eCQM	Process	Y	17.3	26.9	9.30 – 14.80	14.81 – 20.49	20.50 – 26.67	26.68 – 30.66	30.67 – 37.22	37.23 – 42.41	42.42 – 50.88	>= 50.89	No	No
Cardiac Rehabilitation Patient Referral from an Outpatient Setting	243	MIPS CQM	Process	Y	20.1	22.2	8.11 – 11.87	11.88 – 14.62	14.63 – 17.22	17.23 – 20.77	20.78 – 24.31	24.32 – 30.68	30.69 – 44.43	>= 44.44	No	No
Barrett’s Esophagus	249	Medicare Part B Claims	Process	Y	0.2	100	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Barrett’s Esophagus	249	MIPS CQM	Process	Y	4.1	99.5	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Radical Prostatectomy Pathology Reporting	250	Medicare Part B Claims	Process	Y	0.7	99.9	—	—	—	—	—	—	—	100	Yes	No
Radical Prostatectomy Pathology Reporting	250	MIPS CQM	Process	Y	1.5	99.7	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain	254	MIPS CQM	Process	Y	15.3	85.1	74.42 – 80.94	80.95 – 85.36	85.37 – 88.88	88.89 – 91.99	92.00 – 95.23	95.24 – 97.66	97.67 – 99.99	100	No	No
Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain	254	Medicare Part B Claims	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure	255	Medicare Part B Claims	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure	255	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Rate of Open Repair of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post-Operative Day #7)	258	MIPS CQM	Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Rate of Endovascular Aneurysm Repair (EVAR) of Small or Moderate Non-Ruptured Infrarenal Abdominal Aortic Aneurysms (AAA) without Major Complications (Discharged to Home by Post Operative Day #2)	259	MIPS CQM	Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Rate of Carotid Endarterectomy (CEA) for Asymptomatic Patients, without Major Complications (Discharged to Home by Post-Operative Day #2)	260	MIPS CQM	Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness	261	Medicare Part B Claims	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Referral for Otologic Evaluation for Patients with Acute or Chronic Dizziness	261	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Image Confirmation of Successful Excision of Image-Localized Breast Lesion	262	MIPS CQM	Process	Y	0.2	100	—	—	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Sentinel Lymph Node Biopsy for Invasive Breast Cancer	264	MIPS CQM	Process	Y	6.1	98	97.96 – 99.21	99.22 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Biopsy Follow-Up	265	MIPS CQM	Process	Y	29.5	81.8	61.23 – 83.62	83.63 – 95.64	95.65 – 99.37	99.38 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy	268	MIPS CQM	Process	Y	35.9	65	32.00 – 45.34	45.35 – 57.13	57.14 – 78.56	78.57 – 95.99	96.00 – 99.06	99.07 – 99.99	—	100	No	No
Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy	268	Medicare Part B Claims	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Related Iatrogenic Injury – Bone Loss Assessment	271	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy	275	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Sleep Apnea: Severity Assessment at Initial Diagnosis	277	MIPS CQM	Process	Y	26.9	82.1	69.01 – 81.02	81.03 – 90.62	90.63 – 99.70	99.71 – 99.99	—	—	—	100	Yes	No
Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy	279	MIPS CQM	Process	Y	17.8	92	90.08 – 96.26	96.27 – 99.16	99.17 – 99.99	—	—	—	—	100	Yes	No
Dementia: Cognitive Assessment	281	eCQM	Process	Y	35.7	46.1	5.88 – 12.89	12.90 – 26.08	26.09 – 44.99	45.00 – 59.25	59.26 – 73.32	73.33 – 88.56	88.57 – 96.76	>= 96.77	No	No
Dementia: Functional Status Assessment	282	MIPS CQM	Process	Y	32.2	79.2	57.14 – 78.94	78.95 – 95.27	95.28 – 99.12	99.13 – 99.99	—	—	—	100	Yes	No
Dementia Associated Behavioral and Psychiatric Symptoms Screening and Management	283	MIPS CQM	Process	Y	29.9	81.3	58.14 – 83.07	83.08 – 96.66	96.67 – 99.81	99.82 – 99.99	—	—	—	100	Yes	No
Dementia: Safety Concerns Screening and Mitigation Recommendations or Referral for Patients with Dementia	286	MIPS CQM	Process	Y	27.3	82	62.86 – 78.68	78.69 – 89.88	89.89 – 98.20	98.21 – 99.99	—	—	—	100	Yes	No
Dementia: Caregiver Education and Support	288	MIPS CQM	Process	Y	27.9	80.9	59.26 – 77.32	77.33 – 89.32	89.33 – 97.53	97.54 – 99.99	—	—	—	100	Yes	No
Parkinson’s Disease: Psychiatric Symptoms Assessment for Patients with Parkinson’s Disease	290	MIPS CQM	Process	Y	19.2	89.7	85.09 – 92.55	92.56 – 96.91	96.92 – 99.22	99.23 – 99.99	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Parkinson’s Disease: Cognitive Impairment or Dysfunction Assessment	291	MIPS CQM	Process	Y	13.1	93.3	86.49 – 94.99	95.00 – 99.99	—	—	—	—	—	100	Yes	No
Parkinson’s Disease: Rehabilitative Therapy Options	293	MIPS CQM	Process	Y	19.8	86.6	67.03 – 82.94	82.95 – 94.28	94.29 – 99.99	—	—	—	—	100	Yes	No
Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery	303	MIPS CQM	Patient Reported Outcome	Y	30.5	74	45.11 – 70.87	70.88 – 78.76	78.77 – 84.90	84.91 – 91.77	91.78 – 98.79	98.80 – 99.99	—	100	No	No
Cataracts: Patient Satisfaction within 90 Days Following Cataract Surgery	304	MIPS CQM	Patient Engagement Experience	Y	28.4	76.6	50.00 – 72.21	72.22 – 80.29	80.30 – 87.08	87.09 – 95.41	95.42 – 99.11	99.12 – 99.99	—	100	No	No
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment	305	eCQM	Process	Y	6.2	3.3	0.31 – 0.41	0.42 – 0.67	0.68 – 1.02	1.03 – 1.34	1.35 – 2.23	2.24 – 3.84	3.85 – 6.90	>= 6.91	No	No
Cervical Cancer Screening	309	eCQM	Process	Y	25.6	35.1	9.83 – 16.79	16.80 – 23.65	23.66 – 31.53	31.54 – 39.71	39.72 – 48.30	48.31 – 57.62	57.63 – 72.60	>= 72.61	No	No
Chlamydia Screening for Women	310	eCQM	Process	Y	20.2	35.2	16.67 – 22.30	22.31 – 28.04	28.05 – 33.32	33.33 – 39.12	39.13 – 44.77	44.78 – 53.13	53.14 – 63.77	>= 63.78	No	No
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented	317	eCQM	Process	Y	23.6	37.3	19.56 – 24.13	24.14 – 28.18	28.19 – 32.30	32.31 – 36.66	36.67 – 42.11	42.12 – 50.69	50.70 – 74.54	>= 74.55	No	No
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented	317	Medicare Part B Claims	Process	Y	30.1	68	34.25 – 45.47	45.48 – 58.48	58.49 – 73.28	73.29 – 89.40	89.41 – 98.06	98.07 – 99.99	—	100	No	No
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented	317	MIPS CQM	Process	Y	32.7	54.1	25.75 – 30.80	30.81 – 35.46	35.47 – 42.56	42.57 – 59.14	59.15 – 83.48	83.49 – 97.31	97.32 – 99.99	100	No	No
Falls: Screening for Future Fall Risk	318	eCQM	Process	Y	35.4	49.8	7.24 – 20.26	20.27 – 36.40	36.41 – 52.24	52.25 – 66.72	66.73 – 78.59	78.60 – 88.50	88.51 – 96.55	>= 96.56	No	No
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients	320	Medicare Part B Claims	Process	Y	21.1	91.8	95.24 – 97.72	97.73 – 99.99	—	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients	320	MIPS CQM	Process	Y	19.5	88.9	85.00 – 89.73	89.74 – 93.60	93.61 – 95.94	95.95 – 97.72	97.73 – 98.95	98.96 – 99.99	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low Risk Surgery Patients	322	MIPS CQM	Efficiency	Y	16.9	4.1	1.90 – 0.01	—	—	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Routine Testing After Percutaneous Coronary Intervention (PCI)	323	MIPS CQM	Efficiency	Y	16.9	4.4	2.44 – 0.01	—	—	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low-Risk Patients	324	MIPS CQM	Efficiency	Y	13.4	5.1	6.25 – 2.02	2.01 – 0.01	—	—	—	—	—	0	Yes	No
Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions	325	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy	326	Medicare Part B Claims	Process	Y	20.6	89.5	84.13 – 95.28	95.29 – 98.79	98.80 – 99.99	—	—	—	—	100	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy	326	MIPS CQM	Process	Y	18	81.2	69.54 – 75.10	75.11 – 78.89	78.90 – 83.08	83.09 – 88.16	88.17 – 94.93	94.94 – 99.99	—	100	No	No
Pediatric Kidney Disease: ESRD Patients Receiving Dialysis: Hemoglobin Level < 10g/dL	328	MIPS CQM	Intermediate Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Adult Kidney Disease: Catheter Use at Initiation of Hemodialysis	329	MIPS CQM	Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days	330	MIPS CQM	Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse)	331	MIPS CQM	Process	Y	34.5	61.5	92.15 – 87.51	87.50 – 82.89	82.88 – 75.37	75.36 – 64.36	64.35 – 46.68	46.67 – 20.00	19.99 – 0.01	0	No	No
Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)	332	MIPS CQM	Process	Y	15.4	93.2	93.55 – 96.19	96.20 – 97.58	97.59 – 98.39	98.40 – 99.35	99.36 – 99.99	—	—	100	Yes	No
Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)	333	MIPS CQM	Efficiency	Y	6.7	2.2	2.50 – 0.91	0.90 – 0.27	0.26 – 0.01	—	—	—	—	0	Yes	Yes – see “Scoring Examples” tab of spreadsheet
Maternity Care: Elective Delivery or Early Induction Without Medical Indication at >= 37 and < 39 Weeks (Overuse)	335	MIPS CQM	Outcome	N	—	—	—	—	—	—	—	—	—	—	—	No
Maternity Care: Post-Partum Follow-Up and Care Coordination	336	MIPS CQM	Process	N	—	—	—	—	—	—	—	—	—	—	—	No
Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier	337	MIPS CQM	Process	Y	30	72.1	47.06 – 60.60	60.61 – 73.62	73.63 – 82.50	82.51 – 89.99	90.00 – 96.42	96.43 – 99.99	—	100	No	No
HIV Viral Load Suppression	338	MIPS CQM	Outcome	Y	24.2	80.9	74.47 – 78.56	78.57 – 83.99	84.00 – 87.93	87.94 – 93.99	94.00 – 97.23	97.24 – 99.99	—	100	No	No
HIV Medical Visit Frequency	340	MIPS CQM	Process	Y	25.8	71.5	48.97 – 52.85	52.86 – 61.08	61.09 – 82.68	82.69 – 87.99	88.00 – 92.85	92.86 – 95.91	95.92 – 99.99	100	No	No
Pain Brought Under Control Within 48 Hours	342	MIPS CQM	Ou

Client information and presenting issue

March 20, 2023/in HEALTHCARE /by

Template

Client information and presenting issue: Sally Mae is an African American 26-year-old gay female who has been homeless for the past 6 months. Most of that time has been spent couch surfing between the homes of friends. She has a history of substance abuse, battery, assault, and juvenile justice as a teen and is currently on probation stemming from an altercation with her mother. Sally Mae’s mother and step-father highly disapprove of her “lifestyle” and refuse to let her remain at home due to it. In an effort to get Sally Mae off the streets her probation officer, Mike, suggested she join a program that she recently heard about, Turning Point. Any relevant information about setting and demographics: An interview with Sally Mae was arranged between myself, Laura, and Mike. The agreed upon location was a at Coastal Harbor Behavior Health conference room which the inpatient facility client was recently admitted to in an attempt of overdose. When Mike arrived, I escorted him into the conference room where Sally Mae and Laura were seated. We promptly stood up as we greeted Mike and Laura. The following conversation picks up after the initial greetings had taken place and the interview/assessment had started.
Dialogue	Identify skills, techniques and theories,	Analysis/assessment of dialogue	Personal reactions and self-reflection to the interaction
Mike: Sally Mae, we aren’t sure what you know about Turning Point. Can you share what you know, if anything at all.
Sally Mae: The most that I know is this place you name is a home for homeless gay kids like me. That’s it.
Mike: Yes, they do provide a safe place for gay individuals, and for the rest of the LGBTQ community. Along the way we will work with you to establish and meet goals that are important to you. There are of course rules that must be followed.

Clinical Quality Measures for Eligible Providers

March 20, 2023/in HEALTHCARE /by

Final Quality Project Part 4: Clinical Quality Measures for Eligible Providers

Overview

This activity focuses on the Quality Payment Program under MACRA (Medicare Access and CHIP Reauthorization Act). The activity uses online resources from the CMS website. This activity focuses on the Merit Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) for the eligible professional.

Resources

Go to the website CMS.gov (Centers for Medicare & Medicaid Services) to complete the following:

1. Watch an introduction to MIPS: https://youtu.be/CN7_gBGXYq4 2. Watch a video about performance categories: https://youtu.be/oTBkl07SRRo

a. Weights changed for 2018: Quality = 50% and Cost= 10% b. Weights changed for 2019: Quality= 45% and Cost= 15%

Background In the past, providers had several quality payment programs that they participated in to receive reimbursement from CMS. These included a Sustainable Growth Rate, Value-For Service (Fee- for-Service), Physician Quality Reporting, Meaningful Use, and Value Based Modifiers. Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a new Quality Payment Program was instituted that replaced all of the previous programs. Providers are now reimbursed under 1 of 2 programs, the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs). Depending on a providers eligibility, they will be reimbursed using the metrics provided by the appropriate program. Under the MIPS program, providers are rated on a 100 point scale. Their score will determine reductions or incentives from the standard Medicare payment rate. As MIPS is a recent program, starting on January 1, 2017, the first few years are seen as transitional. For 2017, a minimum of 3 points was required in order to stay neutral and not receive any payment reductions. This raised in 2018 to 15 points to remain neutral and not receive any reductions. This is a two year process, so for those who reported for 2017, CMS reviews the scores and data in 2018, and then adjusts the payments for 2019. If a provider falls below the threshold of 3 points for 2017, they will receive a payment reduction in 2019. The table below shows the payment structure for the first few years:

https://youtu.be/CN7_gBGXYq4

https://youtu.be/oTBkl07SRRo

Year Reported Year Adjusted Maximum Reduction Maximum Increase 2017 2019 -4% +12% 2018 2020 -5% +15% 2019 2021 -7% +21%

2020+ 2022+ -9% +27% There are bonuses available through the program for the first 5 years for the very top performers. If a provider scores 70 or higher in 2017, they are eligible for this bonus. A key factor of the program is that it is “budget neutral”. This means that the money received from reductions is used to provide the incentives. While providers may be eligible for an amount up to the maximum increase, their increase will depend on the amount of funds saved from the reductions in payments. MIPS-Eligible Providers:

• Doctors of Medicine (MD) • Doctors of Osteopathy (DO) • Doctors of Dental Surgery (DDS) • Doctors of Dental Medicine (DMD) • Doctors of Podiatric Medicine (DPM) • Doctors of Optometry (OD) • Doctors of Chiropractic (DC) • Physicians Assistants (PA) • Nurse Practitioners (NP) • Clinical Nurse Specialists (CNS) • Certified Registered Nurse Anesthetists (CRNA)

MIPS-Exempt Providers (will remain under Standard Medicare Payment Rate)

• Those not on the above list (through at least the year 2021) • Provider is in their first year of billing under Medicare (under any entity) • Provide bills ≤$90,000 in Medicare per year • Provide sees ≤200 Medicare patients per year • Providers in an Advanced APM (only those classified as Advanced, see next section)

APMs An alternative payment model gives added incentive payments to high-quality and cost- efficient care. Advanced APMs accept risk based on the quality and effectiveness of care provided like an Accountable Care Organization (ACO). Advanced APMs base payment on quality measures comparable to those in MIPS, require use of certified EHR technology, and bear more than nominal financial risk for monetary losses OR are a Medical Home Model under the CMS Innovation Center Authority. Advanced APMs are not required to report under MIPS due to the cost-sharing and risk structure already in place. Providers in Advanced APMs will instead earn 5% incentive payments in 2020 as long as they receive 25% of Medicare Part B payments of 20% Medicare patients. Quality under MIPS The Quality section under MIPS replaces the Physician Quality Reporting System (PQRS) and the quality component of the Value Based Modifier (VBM) program. While this differs in name, it uses the same measures. Under the MIPS Quality reporting, providers are required to report data on 6 measures or participate in a specialty measure set. This must include 1 outcome based measure or another high priority one if an outcome based measure is not available. CMS will compare the providers performance rate to a national benchmark (which is established by looking at the performance rate for the two prior years). The benchmark is divided into deciles which determines the providers score. An example is provided below: Measure 236: Controlling High Blood Pressure: Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period

Measure 236: Controlling High Blood Pressure (EHR Submission) Decile Quality Measure Benchmarks (%) Possible Points Decile 3 51.46-56.82 3 Decile 4 56.83-60.94 4 Decile 5 60.95-64.67 5 Decile 6 64.68-68.17 6 Decile 7 68.18-72.00 7 Decile 8 72.01-76.25 8 Decile 9 76.26-82.20 9 Decile 10 >=82.21 10

If a provider reports that in 2019 they had 72.5% of patients between 18-85 years old with a diagnosis of hypertension and adequately controlled blood pressure they would receive 8 points towards their MIPS Quality category.

There are 270 quality measures to choose from among two types, outcome and high priority measures. Remember, the provider must choose one outcome measure if applicable. In order to become more applicable to all types of providers, there are currently 34 designated specialty measure sets available including:

• Allergy/Immunology • Anesthesiology • Cardiology • Gastroenterology • Dermatology • Emergency Medicine • Pathology • Mental/Behavioral Health

Activity 1 – Answer the following questions: Determine if the following providers are considered “Eligible Professionals” for MIPS. (Y/N)

1. A Doctor of Medicine (MD) who bills $200,000 in Medicare payments per year 2. A Nurse Practitioner (NP) who has 125 Medicare patients 3. A Doctor of Medicine (MD) who is part of an Accountable Care Organization that meets

Advanced APM status 4. A Physician Assistant (PA) who is a member of an APM, but the APM is not considered

Advanced

Critical Thinking Questions

5. The quality category of MIPS decreased the past two years from 60% down to 45%. The cost category rose from 0% to 15%. What are the implications of this for organizations? Will quality be affected? (*Remember this is the percentage of the score they are graded on, not the facility’s actual score. So they are being graded with less of an emphasis on quality and more of an emphasis on cost*)

6. If providers are hospital based, are they exempt from MIPS? Why?

7. A provider in your organization is upset about the changes to the reimbursement programs. They are upset CMS has imposed an all-new quality payment program that changes everything they were doing previously. They feel this is too much new information to learn. Do you agree? Why?

Activity 2 Now that you have a better understanding of MIPS, address the following scenario: You work for a multi-physician pediatric practice. Your organization is preparing for the next year and you are researching quality measures to address under MIPS.

• Open the MIPS Quality Measures file • Go to tab titled 2019 MIPS Quality Measures List • Scroll to the left to find the Specialty Measure Sets, starting in column T • Locate and Filter the list for Pediatric Specialty Measures • You will notice that there are 22 measures available to choose from.

8. Which measure must we report on as it is an outcome measure? (use the quality

number)

After reviewing the quality measures available you make the decision to choose measures that have previous deciles available so that you can perform a comparison and set a quality plan for the year.

• Open the 2019 MIPS Quality Benchmarks • Select the MIPS Benchmark Results tab • Locate all 22 measures from the previous file in the MIPS Benchmark Results tab

9. Do all 22 Pediatric Specialty Measures have benchmarks to compare against? Your team completed an audit and found the results of several measures for your facility. The results are listed below in the chart. Compare the “% of charts that meet the standard” with the decile scores in the MIPS Benchmark Results tab and determine the decile the facility’s current score falls. Record the decile in the table below, you will use these to answer the next few questions. Some measures will be listed multiple times as they have different submission methods available. If available, use the eCQM method line. If they do not have the ability to use eCQM, use the MIPS CQM method line.

10. Does the facility have at least 5 measures that fall in the 10th decile? The facility’s CEO has determined that the 2 lowest scoring measures need to be addressed with quality improvement plans.

11. Which measure falls into the lowest decile (use quality number in answer)?

12. Which measure falls into the second lowest decile (use quality number in answer)? You will now choose one of these 2 measures to begin with. A meeting has been scheduled to discuss the quality improvement initiative.

13. What is the quality number of the measure you choose to focus on first?

14. Why did you choose to address this measure first?

15. Outline a high-level action plan to take to the meeting. (Must include steps of quality improvement including use of quality improvement tools; this does not have to be an in- depth plan specific to the measure, it only needs to outline the high-level steps of a QI plan.)

Quality Number (Q#)

# of Applicable Charts

# of Charts that meet standard

% of charts that meet standard

Decile

65 70 68 97% 66 30 28 93% 91 55 55 100% 93 55 55 100% 110 395 99 25% 134 200 124 62% 239 395 218 55% 240 395 297 75% 305 25 4 16% 310 50 40 80% 379 395 12 3% 402 75 66 88%

This activity focuses on the Quality Payment Program under MACRA (Medicare Access and CHIP Reauthorization Act). The activity uses online resources from the CMS website. This activity focuses on the Merit-Based Incentive Payment System (MIPS) and Adv…
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Business Plan Implementation Schedule

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pure scientists

Foundations of Qualitative Research Worksheet

Foundations of Qualitative Research Worksheet

Exercise 1

Exercise 2

Discuss the three phases of the development methodology as applied to the case project.

Requirements

Instructions

UWG-Pre Planning

UWG-Pre Planning

UWG Clinic

Task 1) – Business Profile

Org. Chart

Task 2) – Business Processes

Task 3) Opportunities

Recommendation

Task 4) – Development Methodology

Historical MIPS Quality Measure Benchmark

Client information and presenting issue

Clinical Quality Measures for Eligible Providers

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