| WoundReference enabler/ tool | ID/Subcategory name | Activity name and description | Weight | Validation | Suggested Documentation (inclusive of dates during the selected continuous 90-day or year long reporting period)
|
TeleVisit Tool 2.0
| IA_EPA_2/ Expanded Practice Access
| Use of telehealth services that expand practice access. Use of telehealth services and analysis of data for quality improvement, such as participation in remote specialty care consults or teleaudiology pilots that assess ability to still deliver quality care to patients.
| Medium | Documented use of telehealth services and participation in data analysis assessing provision of quality care with those services NOTE: For the purposes of this IA, telehealth services include a “real time” interaction and may be obtained over the phone, online, etc. and are not limited to the Medicare reimbursed telehealth service criteria. | 1) Use of Telehealth Services - Documented use of telehealth services through: a) claims adjudication (may use G codes to validate); b) EHR or c) other medical record document showing specific telehealth services, consults, or referrals performed for a patient; and 2) Analysis of Assessing Ability to Deliver Quality of Care - Participation in or performance of quality improvement analysis showing delivery of quality care to patients through the telehealth medium (e.g. Excel spreadsheet, Word document or others) |
TeleVisit Tool 2.0 with built in specialist documentation templates
| IA_CC_1/ Care Coordination
| Implementation of use of specialist reports back to referring clinician or group to close referral loop: Performance of regular practices that include providing specialist reports back to the referring MIPS eligible clinician or group to close the referral loop or where the referring MIPS eligible clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the EHR technology.
| Medium | Functionality of providing information by specialist to referring clinician or inquiring clinician receives and documents specialist report
| 1) Specialist Reports to Referring Clinician - Sample of specialist reports reported to referring clinician or group (e.g. within EHR or medical record); or 2) Specialist Reports from Inquiries in Certified EHR - Specialist reports documented in inquiring clinicians certified EHR or medical records |
| Wound Care and Hyperbaric Oxygen Therapy Knowledge Base condition-specific care plan templates | IA_CC_9/ Care Coordination
| Implementation of practices/processes for developing regular individual care plans. Implementation of practices/processes, including a discussion on care, to develop regularly updated individual care plans for at-risk patients that are shared with the beneficiary or caregiver(s). Individual care plans should include consideration of a patient's goals and priorities, as well as desired outcomes of care.
| Medium | Individual care coordination plans including a discussion on care are regularly developed and updated for at-risk patients and shared with beneficiary or caregiver
| 1) Individual Care Plans for At-Risk Patients - Documented practices/processes for developing regularly individual care plans for at-risk patients, e.g., template care plan; and 2) Use of Care Plan with Beneficiary - Patient medical records demonstrating care plan being shared with beneficiary or caregiver, including consideration of a patient's goals and priorities, social risk factors, language and communication preferences, physical or cognitive limitations, as well as desired outcomes of care |
| Wound Care and Hyperbaric Oxygen Therapy Knowledge Base, algorithms/ pathways, checklists, order sets | IA_BE_12/ Beneficiary Engagement
| Use evidence-based decision aids to support shared decision-making. Use evidence-based decision aids to support shared decision-making.
| Medium | Use of evidence based decision aids to support shared decision-making with beneficiary
| Documentation (e.g. checklist, algorithms, tools, screenshots) showing the use of evidence-based decision aids to support shared decision-making with beneficiary
|
| Go-no-Go Hyperbaric Risk Assessment Tool | IA_PSPA_8/ Patient Safety & Practice Assessment
| Use of patient safety tools. In order to receive credit for this activity, a MIPS eligible clinician must use tools that assist specialty practices in tracking specific measures that are meaningful to their practice. Some examples of tools that could satisfy this activity are: a surgical risk calculator; evidence based protocols, such as Enhanced Recovery After Surgery (ERAS) protocols; the Centers for Disease Control (CDC) Guide for Infection Prevention for Outpatient Settings predictive algorithms; and the opiate risk tool (ORT) or similar too
| Medium | Use of systems, tools and strategies implemented by specialty practices, for tracking specific meaningful patient safety and practice assessment (e.g., ORT or similar tools are permitted).
| Documentation of the use of patient safety tools, e.g. surgical risk calculator, evidenced based protocols such as Enhanced Recovery After Surgery (ERAS) protocols and ORT or similar tools are permitted. The CDC Guide for Infection Prevention for Outpatient Settings, or predictive algorithms, that assist specialty practices in tracking specific patient safety measures meaningful to their practice to meet the intent of the IA.
|
Wound Care and Hyperbaric Oxygen Therapy Knowledge Base, algorithms/ pathways, checklists, order sets
| IA_PSPA_16/ Patient Safety and Practice Assessment
| Use of decision support and standardized treatment protocols. Use decision support and standardized treatment protocols to manage workflow in the team to meet patient needs.
| Medium | Use of decision support and treatment protocols to manage workflow in the team to meet patient needs
| Documentation (e.g. checklist, algorithm, screenshot) showing use of decision support and standardized treatment protocols to manage workflow in the team to meet patient needs
|
Wound Care and Hyperbaric Oxygen Therapy Knowledge Base algorithms/ pathways highlighting use of patient-reported outcomes
| IA_AHE_3/ Achieving Health Equity
| Promote use of Patient-Reported Outcome Tools. Demonstrate performance of activities for employing patient-reported outcome (PRO) tools and corresponding collection of PRO data such as the use of PHQ-2 or PHQ-9, PROMIS instruments, patient reported Wound-Quality of Life (QoL), patient reported Wound Outcome, and patient reported Nutritional Screening.
| High | Participation in a Quality clinical data registry (QCDR) and demonstrated performance of activities to promote use of patient-report outcome tools and corresponding collection of PRO data
| Participation in QCDR, for use of patient-reported outcome tools, e.g., regular QCDR feedback reports demonstrating use of patient-reported outcome tools and corresponding collection of PRO data, e.g., use of PHQ-2 or PHQ-9 and PROMIS instruments |
