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As someone who works within #MedicalQuality, works to improve the care we provide our patients, and has a degree in #informatics and #HealthIT I am very familiar with national quality measures.

#NursesSpeakUp #DoctorsSpeakUp

One of the most common forms of libel AVers through at anyone who disagrees with them is that we are simply doing it for the money, that we are #bought, or #Pharmawhores.

One of the examples they give as an example for this is a HEDIS Measure, CIS.

ncqa.org/hedis/measures…

They purport that physicians are receiving bonuses for each vaccinated child, and that physicians also receive extra moneys for achieving a higher percentage of children who are vaccinated on time. They will often show a document from BC/BS which seems to support this.

What the document fails to give is a context to how Healthcare Effectiveness Data and Information Set (HEDIS) measures are implemented, how they fit within the context of Quality Payment Programs (QPPs), Merit-based Incentive Payment Systems (MIPS), etcetera.

HEDIS measures are one of the many different ways that the Centers for Medicaid and Medicare Services (CMS), and subsequently most private insurance companies, measure the quality of care provided within healthcare.

qpp.cms.gov/mips/overview

This is all part of the move away from Fee-for-Service (FFS) towards Pay-for-Performance (PFP) and Value-Based-Payment (VBP) methodologies.

This is a move to encourage physicians to increase the quality of the care given, and encourage higher quality care. While this is a noble goal, the mechanism utilized is penalizing, not incentivizing.

The way MIPS and other QPPs work is that CMS and insurance companies take a portion of what is the normal payments physicians would receive from services provided, and hold these moneys in escrow, dependent on how the physician performs on their quality metrics.

This percentage of reimbursement can range from 2% (when the program started) up to 15% of the money a provider should receive for the work done.

HEDIS and other quality metrics are used to measure the quality provided, and the physician receives a percentage of this escrow money, depending on how they performed in each of the metrics.

Thus, it may seem that the physician is getting a "bonus" when they meet their targeted immunization rate, but the reality is, this is just money which is part of their reimbursement that was taken away and partially returned, depending on how well they performed.

A example of this would be our countries tax system. When you file a tax return and are eligible for a tax refund, do you consider this a bonus? No, you would say that it is part of what you should have originally been paid, but was withheld until your total tax was determined.

HEDIS Measures, QPP, MIPS, and CIS measures are no different than this, and attempting to convey a message that receiving payments based on these measures is either a misunderstanding of the system, or a deliberate lie.