Coming Soon: Draft Feedback Reports on Cataract Episode Cost Measures for MIPS
CMS and Contractor Acumen Provide Prior Notice of Draft Feedback Reports on Cataract Episode Cost Measures for MIPS
Get Ready to Review Your Report to Provide Feedback on the Draft Measures
This week, CMS and its contractor, Acumen, LLC, began notifying ophthalmologists who have at least 10 attributed cataract episodes in the performance period between June 1, 2016, and May 31, 2017, that on October 16, they will be able to download a draft feedback report on an episode-based cost measure for cataract surgery currently being developed for inclusion in the Cost category of MIPS. As you are aware, the Cost category will not be included in the 2017 MIPS final score, and CMS proposes the same for 2018. Therefore, these reports are for information only and to test the measures. The reports will be available for review in the CMS Enterprise Portal, similar to PQRS and QRUR reports. See below for full download instructions.
ASCRS has been participating in the development of the cataract episode measure by serving on a CMS-appointed technical expert panel (TEP). We have long been critical of CMS’ existing cost measures—first finalized as part of the Value-Based Payment Modifier (VBPM) and then continued in the Cost category of MIPS—since the measures are primary care-based, use a flawed attribution methodology, and are not risk adjusted. As directed by the MACRA statute, CMS must develop episode-based measures for MIPS that will be more relevant to specialty care. These episode-based measures will be used in addition to the existing measures. CMS is beginning the process by developing and testing eight episode measures, including cataract surgery.
In the development of the new cataract episode measure being tested, ASCRS and our physician representative on the TEP have sought to influence the process so that physicians performing cataract surgery will know which patients are attributed to them, and understand which costs are included in the measure.
Following that advocacy, the new measure currently only includes routine cataract surgery (66984) and excludes patients with significant ocular comorbidities using PQRS measure exclusionary criteria. Most significantly, the measure breaks cataract surgeries into several sub-groups, facility type ASC vs. HOPD, co-managed and not co-managed, and bilateral vs. unilateral, to ensure physicians are not being evaluated on factors outside of their control.
Please keep in mind that these measures are still in draft form and may change following this test phase. Physicians are encouraged to provide feedback to CMS and its contractor Acumen when they review their reports. Acumen will make a confidential online survey available to physicians to provide feedback when the reports are released. ASCRS will also be providing comments.
How to download your report:
The field test reports will be distributed through the CMS Enterprise Portal, which CMS has used in the past for distributing Quality and Resource Use Reports.
If you do not already have an EIDM account, you can set one up and get access to a “Physician Quality and Value Programs” role in preparation for accessing your field test report by using this guide.
- Please note: Field test reports are separate from QRUR reporting, although the same guide may be used to set up an EIDM account.
- If you are applying for a Security Official or an Individual Practitioner Role and the TIN/NPI combinations entered match with the Provider Enrollment, Chain and Ownership System (PECOS) information, then the role is automatically approved within a few minutes of the role request submission.
- If an invalid TIN/NPI combination is entered more than three times, the request is forwarded to the QualityNet help desk and the process has to be manually verified. This takes 24 to 48 hours.
- If you are applying for a Group Representative or an Individual Practitioner Representative Role, the request is forwarded to your Security Official or Individual Practitioner, and the time frame is based on how long it takes the Security Official or Individual Practitioner to approve your request.
If you think you may already have an existing EIDM account but aren’t sure if it is still active, you can check whether your account is still active in preparation for accessing your field test report by attempting to log in.
- If it is unlocked or active and you’ve forgotten your password, you can use the “Forgot Password” function and reset your password by answering the Challenge Security questions that you set up at the time of initial EIDM account registration.
- If it is locked or inactive, you will need to contact the QualityNet help desk at 1-866-288-8912/ TTY: 1-877-715-6222 to unlock it.
If you already have an active EIDM account but need access to a “Physician Quality and Value Programs” role, please do so by using this guide.
If you already have an active EIDM account and have access to a “Physician Quality and Value Programs” role, you should be able to access your field test report by logging into the EIDM portal.
While we expect most ASCRS members will receive a report, physicians who did not bill 66984 under Medicare Part B between the test dates or did not have enough attributed episodes will not receive a report. If you do not receive a report, CMS is making resources, including a mock report, available on its website when the reports are distributed for review and comment.
If you have additional questions, please contact Allison Madson, manager of regulatory affairs, at firstname.lastname@example.org or 703-591-2220.