Interpreting Your Quality Measure Scores (Healthmonix Portal)

Understanding your Quality Measure Scores is a crucial step towards improving your scores in Healthmonix. In this article, we'll cover the following topics:

• Tips for Success
• Improving Your MIPS Score
• HM Measures

Tips for Success

• Benchmarked measures provide the best opportunity to score more points for the quality measure domain. For more information on benchmarked measures, click here.
  • Benchmarked measures that still have room for national improvement are worth 10 points.
    • Measures #126, #127, #128, #155, #181, #182, #226
  • Benchmarked measures that are already doing very well nationally are worth 7 points (aka topped out)
    • Measures #130, #154

• Benchmarked measures have different benchmarks, so the same performance may not result in the same MIPS score when comparing measures.
• The ability to achieve the maximum number of points on a benchmarked measure depends on the following:
  • A clinician has reported the measure on at least 20 unique patients who are eligible for that measure AND
  • A clinician has reported the measure on at least 70% of all patients who are eligible for that measure (Completion Threshold) AND
  • A clinician has reported they performed the quality actions (Measure Met) as often as possible (Performance Rate)
• Measures without benchmarks are worth a maximum of 3 points.
  • Measures #217-222, #478, and HM #4-8

Check out the MIPS FAQ for common questions and helpful resources.

Improving Your MIPS Score

1. Performance: Review the performance rate for each measure. A performance rate that is less than 100% indicates some NPIs in the group are reporting “Not Met” for the measure. A lower performance rate will prevent you from achieving the maximum level of points. 
   1. For example, #128 has a Performance of 96.7%. 6.89 Actual Points were achieved out of the 10 Total Possible Points. Optimize by reporting “Met” as often as possible for the performance period.
      
2. 20 Instances: To achieve maximum points, you’ll need at least 20 eligible patients for each measure during the year, whether or not the measure was actually reported. “No” indicates that you have not achieved the 20 patient threshold. The number in parenthesis is the number of eligible patients. 
   1. For example, only 4 patients meet the eligibility criteria for Measure #154. To score above the 3 point threshold, 16 additional patients 65 or older would need to visit before December 31 and answer “Yes” to the question “Has the patient fallen at least once and been injured, or has fallen at least twice, in last 12 months?” If a patient answers “No” to that question, the patient is not eligible for Measure 154, so the Total Possible Points are not earned. 
      Note: Although the 20 case requirement was not met, 3 points are still achieved because the therapist did meet the 70% data completeness standard. This falls under the Class 2 scoring system.
      
3. Completion Threshold: The total number of eligible patients who had a measure reported in some way (Measure Met, Excluded, Not Met). The minimum to achieve at least 3 points is 70%.
   
4. Actual Points: The total number of points earned. A lower Performance rate will prevent you from achieving the maximum number of points for each measure. To optimize your Actual Points, report “Met” as often as possible by the end of the year.
   
5. Predicted Points: The number of points predicted to be achieved based on performance and completion rates.
   
6. Total Possible Points: The total number of points possible for measure reporting. This is determined by the QPP during the final rule.
   
7. Top 6: This indicates these measures are your six highest scoring quality measures.
   
8. Send to CMS Status: This indicates that you’ve chosen these to send to CMS as part of your data submission. This does not indicate that the measures have been already sent. Sending your data begins in January of 2021.
   

Curious about what it takes to get into the bonus range for MIPS? MIPS eligible therapists with a final score above the 2020 performance threshold (85 points) are eligible for an additional positive adjustment for exceptional performance. Click here to learn more about the exceptional performance threshold. 

To learn more about MIPS scoring methodologies, click here. 

HM Measures

A patient is eligible for an HM measure when they:

• Meet or exceed the minimum age requirement
• Have a qualifying ICD-10 code
• Have a date of service on an evaluative note (Initial Evaluation, Progress Note, or Discharge Summary) for the current performance year

If you do not have MIPS enabled, those patients will be recognized as missed opportunities by CMS.

If you do have MIPS enabled,

• HM4: Arm — QuickDASH (Disability of the Arm, Shoulder, and Hand)
• HM5: Neck — Neck Disability Index (NDI)
• HM6: Low Back — Modified Oswestry 
• HM7: Dizziness — Dizziness Handicap Inventory (DHI)
• HM8: Leg — Lower Extremity Functional Scale (LEFS)

HM Measures and Healthmonix

When patients come to therapy with multiple ICD-10 codes, Healthmonix QCDR is unable to filter the primary diagnosis or main reason for treatment. This occurs with HM measures and FOTO measures.

Patients with multiple ICD-10 codes may be counted as “eligible” for

• Multiple HM or FOTO measures. This is because the Measure Specifications contain overlapping ICD-10 codes for certain measures.
  • For example, the patient has an ICD-10 code for shoulder pain and an ICD-10 code for neck pain. Because Healthmonix QCDR does not have a filter for the primary diagnosis, the patient is eligible for HM4 and HM5. 
• More than one instance for the same measure
  • For example, the patient has an ICD-10 code for shoulder pain and an ICD-10 code for elbow pain. Because HM4 covers both scenarios, the patient is eligible for HM4 twice.

HM Measures in the WebPT EMR

The Initial Evaluation questionnaire must have a date of service in the current performance year. If you are reusing a patient's case, we recommend starting a new one to ensure HM measures function accordingly.

The primary OMT (survey) selected by the therapist in the Initial Evaluation will determine which HM measure is shown on the MIPS tab. 

• For example, a patient has an ICD-10 code for shoulder pain and a code for neck pain. If you select the QuickDASH as the primary OMT during the Initial Evaluation, then HM4 will display on the MIPS tab in the next evaluative note. Alternatively, if you select the Neck Disability Index (NDI) as the primary OMT,  then HM5 will display on the MIPS tab in the next evaluative note.

HM measures are configured not to display when:

• The initial OMT was collected in a different CLID than the follow-up OMT. 
• There is not a relevant ICD-10 code for the HM measure
• The OMT used for the HM measure is not selected as the primary OMT on the Initial Evaluation
  • For example, you want to report on HM7 (Dizziness) but you select the Berg Balance Scale as the primary OMT instead of the Dizziness Handicap Index (DHI). HM7 reporting will not appear on the MIPS tab; however, the patient will still count towards the Total Instances in the Healthmonix column. This can happen with any of the measures, so you must make a clinical judgement when selecting the appropriate OMT during the Initial Evaluation.
• An assistant creates the progress note. The billing therapist must create the note, then the PTA/OTA can re-open to complete it.