Improving Access and Your MIPS Score By Angie Lee

By Angela Lee, Director of Operations at BC Educators

With 16 years of experience in dermatology, I've worn many hats, from front office to back office (MA/Scribe) and served as a dedicated Biologic Coordinator and MIPS Officer. These roles have given me a comprehensive understanding of the importance of each position in ensuring patients gain access to life-changing therapies.

Effective communication between healthcare providers (HCPs) and dermatology medical assistants, scribes, and nurses is crucial for improving prior authorization (PA) outcomes. This can be achieved through detailed documentation and the use of scoring tools. By doing so, you not only enhance patient access but also improve your MIPS score, depending on the quality measures your practice has selected.

Here are some practical steps to improve your documentation and approval outcomes:

1. Body Surface Area (BSA) Documentation: Record initial and updated BSA for conditions like psoriasis (PsO), atopic dermatitis (AD), and prurigo nodularis (PN).

2. Affected Areas: Always include affected areas, especially sensitive ones such as genitals, hands, feet, and eyelids.

3. Patient-Reported Itch Scores: Document itch scores (1-10) for PsO and dermatitis.

4. Disease Severity Scoring Tools:

   • Psoriasis: PGA (Physician Global Assessment)

   • Atopic Dermatitis: IGA (Investigator's Global Assessment)

   • Hidradenitis Suppurativa: Hurley Stage

   • Alopecia Areata: SALT Score

5. Quality of Life Details: Include detailed information on how the condition affects the patient's mental health, work/school, interpersonal relationships, and sleep.

6. Comprehensive Medical History: Ensure an updated medication list, allergies, current/past medical conditions, and surgical history are included. This is crucial for prescribing appropriate therapy and determining comorbidities and contraindications.

7. Document Tried and Failed Therapies: Record all previously attempted therapies and their outcomes.

   The following MIPS measures are dermatology-specific and can help improve patient access to essential therapies:

• MIPS 176: TB Screening Prior to First Course of Biologic Therapy

• MIPS 410: Psoriasis: Clinical Response to Systemic Medications

• MIPS 485: Psoriasis – Improvement in Patient-Reported Itch Severity

• MIPS 486: Dermatitis – Improvement in Patient-Reported Itch Severity

  By adhering to these documentation practices and MIPS measures, you can enhance patient access to therapies and improve your practice's MIPS score. Consider creating cheat sheets for HCPs and scribes and develop protocols (in EMA) or diagnosis/medication-specific templates (for other EHRs) to streamline these processes.