“Click here.” “Make sure this field is filled out.” “Make sure the doctor says this in the plan.”

Since the Affordable Care Act led to policies like the Physician Quality Reporting System (PQRS) and the Merit-Based Incentive Payment System (MIPS), anyone who has worked in a clinic has heard these words. These systems may make patient care feel like a series of boxes to check along with an alphabet soup of entities that require it. Doctors complain about how many clicks they have on each screen, technicians are tired of being told that they are missing things, and administrators are trying to keep up with policy requirements.

There are ways to make life easier for everyone in the office, and believe it or not, your electronic medical records (EMR) system may be the key. Here, I explain how your EMR system can help you meet MIPS requirements.

What EMR can do for you

Most EMR software has built-in workflows to meet clinical quality measures for MIPS. Exam templates with shortcuts and macros that are associated with each diagnosis and impression/plan can often be customized for your practice on the back end to include all necessary verbiage to help meet these measures. This is not meant to make exams robotic or to take away from the personalized care that each patient deserves. Rather, it is meant to guide the exam and to remind the technician and doctors to touch on certain topics.

It is important to note that the advisory groups that the Centers for Medicare and Medicaid Services (CMS) has charged with creating these measures are made up of ophthalmologists, technicians, and other experts in the field. In fact, CMS hosts live webinars where they accept questions and conduct feedback seminars on a regular basis from end-users. The measures and their requirements are not arbitrary — they have been designed by people just like you!

The best way to be successful in meeting the MIPS measures is to use the processes that your EMR has in place, customize them to fit your practice’s unique patient-care experience, and understand why these steps are followed. This is the case if you are reporting through a clinical data registry, through your EMR or directly, or uploading your files into CMS to report manually.

Glaucoma and diabetes are two conditions with multiple MIPS measures attached to them. Luckily, you can use your EMR as a tool to meet the measures every time!

Glaucoma measures

There are two glaucoma MIPS measures. These are often difficult to meet because they are based on a patient’s historical pre-treatment intraocular pressure (IOP) and physical evaluation, both of which are not always part of a normal workflow. Certain EMR systems have dropdowns or checkboxes that are mapped to their monitoring programs that allow the measure to be met. For those who work with a registry, certain phrases and terms can be mapped in the plan to meet the measures.

For instance, when glaucoma is diagnosed, the patient and the exam are counted toward the measure. This means that these processes are all parts of the data that CMS is collecting and using to establish quality standards of care for practitioners who treat glaucoma:

• Checking the patient’s pressure
• Recording the patient’s diagnosis in an accurate and detailed way to include the laterality and severity
• The patient’s exam findings, including cup-to-disc (C/D) ratio and evaluation of the nerve
• A detailed plan of care, which must include the patient’s treatment and the pressure goal.

For example, regarding IOP: “The patient states that their pressure was 25 mm Hg when diagnosed 15 years ago. It is 18 mm Hg on examination today, which is greater than 15% pressure reduction from pre-intervention.” Another example: “The patient is not sure what their pressures were when they were diagnosed, but their visual fields and retinal nerve fiber layer appear stable on exam while on current treatment. Continue current treatment, and follow up in 6 months.” These “plans of care” meet the qualifications for the measure.

The more detailed the charting, the better off a clinic is when it comes to audit-proofing their charts. Making sure that documentation in the plan is detailed and specific to individual patients ensures that your chart notes are a slam-dunk to make it through a MIPS audit request with confidence.

Along with pressures, not every provider does a physical exam at follow-up appointments for glaucoma, so the C/D ratio may not be evaluated at every glaucoma visit. However, one glaucoma MIPS measure requires that the C/D ratio is documented in the medical record at least once per year. The struggle with monitoring this measure is that practices tend to score poorly for most of the year. The reason is not the fault of the practice — this occurs if patients simply have not returned for their dilated or physical exams. If the doctor is one of the many across the country who do not evaluate the C/D at undilated visits, then the patient with glaucoma will count in the denominator (the list of patients being treated for glaucoma) but not in the numerator (those who have had their C/D evaluated for the calendar year).

Once the patient undergoes a physical exam where the C/D is recorded, the measure is met for that patient, and they will then be counted in the numerator. This can be very stressful for those who are regularly monitoring these measures.

Fortunately, EMR software has an easily accessible history. If a patient is not dilated and a C/D needs to be recorded, the doctor has the ability to view the undilated C/D and compare it to the last dilated exam to feel more confident in their evaluation. Doing a physical examination on glaucoma patients at the beginning of the year or at their first visit to the clinic in a calendar year is a simple way to use your EMR to help you meet measures efficiently.

Diabetes measures

When it comes to diabetes, you can use your EMR to follow the same steps for each diabetic patient, which will allow you to meet up to three measures at once. The best way to meet these measures is to ensure the following:

• Diabetic patients have been dilated once per calendar year by looking at the exam history
• Your exam shortcuts have specific verbiage that is required to meet the measures
• Your EMR codes ICD-10 as detailed as possible to report the severity of retinopathy
• Your EMR sends a letter to the patient’s primary care physician every time you see them for a dilated visit.

Most, if not all, EMRs are able to do these steps easily, but ensuring that staff is aware of how these mechanisms work is essential to meeting these measures.

The diabetic letter measure is one of the few that can be completed any time during the calendar year. Running reports in your EMR on a regular basis is a great way to find the patients who did not have letters sent.

Conclusion

Oftentimes, it may feel like your EMR is working against you; however, compliance itself is baked into the inner workings of your software. Taking the time to learn the processes necessary to unlock shortcuts to meet measures will not only save you time but may improve patient care overall.

Empower technicians to be familiar with CMS requirements by adding MIPS training specific to your clinic’s EMR. This will give them more confidence to use the system and will allow them to help find gaps in patient care.

Your day can feel like a frustrating set of clicks and steps to follow, but remember that your EMR is a powerful tool to provide the best patient care while achieving MIPS compliance. OP

For more information on the MIPS program and clinical quality measures, visit qpp.cms.gov .