Payment & Delivery Models

Up your MIPS score by tallying efforts to prevent chronic disease

Alignment is an often-used word in health care, and the AMA is demonstrating what it can look like by giving physicians engaged in critical efforts to prevent heart disease and diabetes a road map to earning credit for that work under Medicare’s 2018 Merit-Based Incentive Payment System (MIPS).

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Preventing diabetes and heart disease are keys to the AMA’s vision for helping patients live longer and healthier lives. And the AMA has developed resources to help physicians address these two giant health concerns while also helping them successfully navigate MIPS.

The AMA’s resources on prediabetes and hypertension focus on how physicians can help their patients improve their health and their MIPS performance scores at the same time.

The documents add to the AMA’s library of physician resources already available, such as:

The documents outline the different MIPS performance measures that relate to diabetes prevention and hypertension management, potential MIPS score results and related AMA resources to help guide practice activity.

Aligning prevention and promotion

For example, if you are focusing on prediabetes and want to score in the MIPS’ Promoting Interoperability performance category (formerly dubbed Advancing Care Information) and have a 2015 Edition EHR, the AMA’s prediabetes resource suggests exploring the patient-generated health data measure.

To get credit, a practice needs to incorporate patient-generated health data or data from a nonclinical setting into its electronic health record for at least one patient. The document recommends using the AMA’s prediabetes risk test using either the test’s online screener or patient-portal messaging.

The document also provides prediabetes-related recommendations for the MIPS’ Improvement Activities category, but notes that there are no relevant diabetes-prevention measures in the Quality category.

High BP control is high priority

To score in the MIPS’ Quality performance category, the AMA suggests working on quality measure No. 236, Controlling High Blood Pressure, a “high-priority” measure. This involves controlling the BP of 60 percent of a practice’s patients who have been diagnosed with hypertension to under 140/90 mmHg. If you are reporting the measure through the claims option, you only have to document and report the measure on your Medicare’s Part B patients to receive MIPS credit.

To help practices score well in this category, the document identifies AMA resources for ensuring accurate BP measurement, patient-education materials and recommended treatments for each BP threshold.

The document also provides BP-related recommendations for the MIPS Promoting Interoperability and Improvement Activities performance categories.

The AMA offers free personalized consulting and assistance in implementing diabetes-prevention and BP quality-improvement programs. For information on this service, email the AMA Improving Health Outcomes group at [email protected].

Prevent Diabetes STAT is a partnership with the Centers for Disease Control and Prevention (CDC). The AMA is also working with the YMCA to refer patients to CDC-recognized lifestyle change programs and with AmeriCares to increase the availability of these programs.

Target: BP is a national initiative co-led by the American Heart Association and the AMA. In addition to direct access to trained field support specialists, a data platform and a suite of evidenced-based tools and resources offered by the AMA and the AHA, Target: BP offers annual, recurring recognition for all participating sites that achieve hypertension control rates of 70 percent or higher among their adult patient population year over year.