The initial year for MIPS, 2017, was relatively easy for providers, many of whom were able to achieve a perfect final score of 100. Naturally, providers chose measures that were relatively easy to perform well on, that is, they picked the “low hanging fruit.” This year, 2018, is a bit tougher when it comes to MIPS strategy, since the Quality benchmarks have changed. One of these changes is the classification of certain measures as “topped out”.
As providers learn to master certain quality measures, and achieve scores which are clustered at the top, CMS declares the measure “topped out” and will award a maximum of 7 points instead of the full 10. During 2018, there six topped out measures:
| MIPS Measure Number | Name | Specialties |
| 21 | Perioperative Care: Selection of prophylactic Antibiotic – First or Second Generation Cephalosporin | General Surgery, Orthopedic Surgery, Otolaryngology, Thoracic Surgery, Plastic Surgery |
| 23 | Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in all Patients) | General Surgery, Orthopedic Surgery, Otolaryngology, Thoracic Surgery, Plastic Surgery |
| 52 | Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy | Pulmonary Medicine |
| 224 | Melanoma: Overutilization if Imaging Studies in Melanoma | Dermatology |
| 262 | Image Confirmation of Successful Excision of Image-Localized Breast Lesion | Radiology |
| 359 | Optimizing Patient Exposure to Ionizing Radiation: Utilization of a Standardized Nomenclature for Computed Tomography (CT) Imaging Description | Radiology |
Looking ahead to 2019, Eagle Consulting anticipates multiple additional topped out measures. Candidates include Use of High-Risk Medications in the Elderly (238), Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention (441) , Tobacco Use and Help with Quitting Among Adolescents (226), Pain Assessment and Follow-Up (131), Care Plan (47) and others.
For 2017 and 2018, the initial two years of the MIPS program, practices have been adept at locating the “low hanging fruit,” that is, measures for which it is relatively easy to achieve perfect scores. As we look forward to MIPS strategy in 2019, most of the low hanging fruit will be all picked. Practices who are committed to the MIPS track should monitor measures at risk of becoming topped out. Practices using these measures need to explore new measures now, well in advance of 2019, in order to maintain a high MIPS final score. Since the “easy” measures will no longer earn top scores, practices should be prepared for a more difficult era in the subsequent years of MIPS.
