Using data to improve care plays an essential role in delivering quality healthcare for patients, and succeeding in the Merit-Based Incentive Payment System (MIPS). Barriers such as cost, limited staff, and convenience often restrict access to the tools necessary to track and send quality data to CMS. As a result, submitting quality data to MIPS through the CMS web interface, or a third-party data-submission service such as an EHR (Electronic Health Record) registry, or a qualified clinical data registry is not always an option for smaller practices. For those practices that fit this scenario, claims-based reporting is usually the only option. With claims-based reporting, clinicians must use codes specified by CMS that indicate a particular quality measure was performed with a patient. For healthcare professionals, the claims-based method can be difficult to track and labor intensive.

PTN groupPictured: Comprehensive Adult Medicine, Wichita Top to bottom: Carlene Klassen, MD; Amy Blincoe, MA, Glenda Murray, OM; Didi Henriques, RN (Not pictured, Kim Jones, MA)Throughout 2016, Dr. Carlene Klassen and her staff at Comprehensive Adult Medicine, Wichita, worked with the Kansas Practice Transformation Network (PTN) to develop a plan that addressed how to succeed in MIPS via claims-based reporting.

Lead Nurse Didi Henriques and Office Manager Glenda Murray worked with their PTN Quality Improvement Advisor, to develop an efficient and effective way to track clinical quality measures and report the measures via claims. Henriques modified the EHR health maintenance section to include alerts that appear both when specific quality measures apply to patients and if that measure has been completed. Murray, who reviews the claims for the practice, utilizes the modified health maintenance section to verify completion of quality measures, allowing addition of appropriate codes. 

The Wichita practice sees more than 800 patients a year; these coding changes have resulted in considerable time savings for the practice and also provides a streamlined tracking methodology for patient compliance.