BC Advantage

MIPS ELIGIBLE MEASURE APPLICABILITY (EMA) – NEW RESOURCES

Quality is one of four performance categories under the Merit-Based Incentive Payment System (MIPS). For 2017, to fully participate in the Quality performance category, a provider or group must report on:

Six quality measures, one of which is required to be an outcome measure, if available. If an outcome measure is not available, then providers must submit a high priority measure. The provider or group would also have to meet the data completeness requirement (at least 50% of possible data submitted) for each measure submitted.
OR
A complete specialty measure set. All of the measures in a specialty set (i.e., measures specifically for specialties, such as anesthesiology, cardiology, or ophthalmology) will be assessed when less than 50% of possible data are submitted.

If the provider or group submits data on fewer than six quality measures, CMS will conduct an eligible measure applicability (EMA) process to identify clinically related measures the provider or group could have submitted. The EMA analysis applies only if the provider or group submits data through claims or a qualified registry, and if the provider or group submits less than the required quality measures for a program year.

The EMA process uses a clinical relations test to see if the provider or group could have submitted more measures, including outcome and high priority measures, and adjusts the scoring to accurately reflect how the clinical relations test affected the provider's or group's performance.

To learn more about the EMA analysis and how it affects the quality performance calculation and score, visit:

Source: MAB