CMS MIPS Quality Measures Are Blind to High-Need High-Cost Homebound Older Adults Cared for in Home-Based Medical Care




Bhatnagar, Shivani


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Purpose: Multiple studies find home-based medical care a solution for high-need, high-cost homebound older adults. However, home-based medical care needs proper representation among the Merit-based Incentive Payment System (MIPS) and Center for Medicare and Medicaid Services (CMS)-specified quality measures to be financially viable in modern value-based care. Unfortunately, many useful measures for this population are unusable due to inadequate home medical visit codes in these measures' denominators. The objective of this study is to determine what proportion of the CMS 2019 MIPS Quality Measures, which are potentially appropriate for patients receiving home-based medical care, have home visit codes in their denominators. Methods: All 257 CMS 2019 MIPS Quality Measures were reviewed for applicability to homebound older adults cared for by home-based medical care providers. Measure details were reviewed in public documents from five CMS websites across 2017-2019. Results: Of the 257 CMS 2019 MIPS Quality Measures, 179 were inapplicable for this population, most commonly because they applied to specialist physicians outside of geriatric or palliative providers. Of the 78 measures that were deemed potentially appropriate, only 37 (47%) had home visit codes. Conclusions: The majority of CMS MIPS Quality Measures that are potentially appropriate for the care of homebound older adults, who receive home-based medical care, are unusable by home-based medical care practitioners for MIPS reporting. This represents a barrier for home-based medical providers in delivering effective care to this high-need, high-cost vulnerable patient population.