Physician Quality Programs

HMPAQ Partnership Strategy:

  •  Provide expert guidance on CMS and Managed Care Quality Programs in support of independent physicians: Merit Based Incentive Payment System (MIPS), BCBSTX Bridges to Excellence (BTE) & GI Quality Improvement Consortium (GIQuIC).
  • Build a Network of Physician Population Health Partners for Houston Methodist Employees/Spouses and other self-insured Houston Direct-to-Employer opportunities.
  • Communicate Houston Methodist Marquee Programs in each region to Houston Methodist Physicians' Alliance for Quality (HMPAQ) Physicians.


Our Quality Integration Specialists Team works in tandem with aligned physicians with HMPAQ to achieve national and regional quality program recognition and incentives such as those associated with MIPS and BTE.


Merit Based Incentive Payment System (MIPS)


MIPS focuses on performance improvement in 4 key areas: Quality, Improvement Activities, Promoting Interoperablity, and Cost. MIPS was designed to tie payments to quality and cost effective care, drive improvement in care processes/health outcomes, increase the use of healthcare information and reduce the cost of care.  The MIPS Performance Year begins on January 1 and ends on December 31 each year.  Program participants must report data collected during one calendar year by March 31 of the following calendar year.  For example, if you collected data in 2019, you must report data by March 31, 2020 to be eligible for a payment increase and to avoid a payment reduction in 2020. 

Quality


This performance category replaces PQRS. This category covers the quality of the care you deliver, based on performance measures created by CMS, as well as medical professional and stakeholder groups. You pick the six measures of performance that best fit your practice.


Promoting Interoperablity

 

CMS is re-naming the Advancing Care Information performance category to Promoting Interoperability (PI) to focus on patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT). This performance category replaced the Medicare EHR Incentive Program for EPs, commonly known as Meaningful Use. This is done by proactively sharing information with other clinicians or the patient in a comprehensive manner. This may include: sharing test results, visit summaries, and therapeutic plans with the patient and other facilities to coordinate care.


Improvement Activities

 

This is a new performance category that includes an inventory of activities that assess how you improve your care processes, enhance patient engagement in care, and increase access to care. The inventory allows you choose the activities appropriate to your practice from categories such as, enhancing care coordination, patient and clinician shared decision-making, and expansion of practice access.


Cost

 

This performance category replaces the VBM. The cost of the care you provide will be calculated by CMS based on your Medicare claims. MIPS uses cost measures to gauge the total cost of care during the year or during a hospital stay. Beginning in 2018, this performance category will count towards your MIPS final score.




BCBSTX Bridges to Excellence (BTE)

Millions of Americans have some form of diabetes, and millions more cases are not diagnosed. In an effort to improve quality outcomes and encourage more effective treatment and management, the Quality Integration Team works with HMPAQ physicians to successfully achieve Bridges to Excellence Diabetes Recognition.  This recognition accesses a broad range of diabetic metrics that effect patient health and overall wellness. 

Clinicians must meet benchmarks on the following measures to earn recognition:

  • Blood pressure
  • Low-density lipoprotein (LDL) cholesterol levels
  • Glycated hemoglobin (HbA1c) levels
  • Ophthalmological Exams for Retinopathy
  • Nephropathy assessments (microalbumin)
  • Diabetic Foot Exam
  • BMI and Nutritional Consultation


BTE Recognition is also available for Coronary Artery Disease (CAD) and Asthma, for those who qualify.

GI Quality Improvement Consortium (GIQuIC)

The American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy jointly established the nonprofit educational and scientific organization GI Quality Improvement Consortium, Ltd. (GIQuIC) in 2009. 

GIQuIC is raising the bar on efficiency, effectiveness and reliability in bench marking. Physicians from hospitals, universities, ambulatory surgery centers and office-based endoscopy units nationwide are participating in this groundbreaking initiative by collecting and electronically reporting on quality indicators for colonoscopy.

 

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