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Measure 137


Melanoma: Continuity of Care–Recall System

Description: The percentage of patient visits with a current diagnosis or history of melanoma whose information was entered into a recall system to achieve consistent follow-up.

Measure ID: 137

Type: Structure

CMS Derm Specialty Set: Yes

High priority: Yes

Topped out: No

Reporting methods: Registry/QCDR

Maximum Points: 10

Measure purpose: This measure ensures that clinicians use a recall system for patients with a current diagnosis or history of melanoma, to achieve consistent follow-up with patients who either miss a scheduled appointment or did not schedule an appointment within a specified timeframe.

Calculation

The numerator: The number of patients whose information is entered into a recall system that includes a target date for the next complete physical exam and a process to follow up with patients who either did not make an appointment within the specified timeframe or who missed a scheduled appointment

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The denominator: All patients with a current diagnosis of melanoma or a history of melanoma.

Measure calculation example

Dr. Lòpez saw 157 patients during the reporting period who were diagnosed with melanoma or who have a history of melanoma. This is the denominator.

Dr. Lòpez entered patient information into a recall system 153 times. This is the numerator.

Quality of patient care = 153/155. Dr. Lòpez has a score of 98.7% for this measure. This translates to 4.0 to 4.9 points.

Important note

Because of how this measure is structured, physicians score 3 points even if they report on only one patient. Physicians receive no additional score for reporting scores that fall below 83.83%. For example, if Dr. Lòpez reported on 1 patient encounter, she would earn 3 points. A score of 99.9% earns 5.9 points, while a score of 100% earns 10 points. In effect, there is a large gap in earned points between a nearly perfect score and a perfect score.


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Quality measure score benchmark

CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. Points achieved for the Quality category will account for 45% of the overall MIPS score.

Below 3 Decile 3Decile 4Decile 5Decile 6Decile 7Decile 8Decile 9Decile 10
Performance rate  1 patient 83.83 - 
94.33
 94.34 - 
98.79
 98.80 - 99.99 -- --   -- --  100% 
Points   3 - 3.9 4 - 4.9 5 - 5.9 6 - 6.9 7 - 7.9 8 - 8.9 9 - 9.9  10

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