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MACRA Quality Measures

ABG QCDR, Shared QCDR, and MIPS measures defined.

Types of MACRA Quality Measures

Quality Measures account for 75% of your Composite Performance Score (CPS), and you can only report a maximum of 6 measures. These measures come in 2 flavors: “QCDR Measures” or “MIPS Measures”. They have some very important differences.

"QCDR Measures"

These are owned by individual Qualified Clinical Data Repositories (QCDRs). These private entities apply for certification with CMS every year, and every year, CMS needs to recertify each of their measures. In order to report “QCDR Measures”, we will register your providers with the QCDR and simply pass on any registrations fees directly to you. These “QCDR Measures” are designed specifically for general anesthesia practice and make finding 6 applicable measures for the Quality portion of your CPS much easier.

"MIPS Measures"

These are directly owned by CMS and carry the additional data burden of requiring CPT codes for each case. That is, the denomitator exclusion criteria for any given MIPS measure is a function of the CPT code for the case. This code is often not available for days after the completion of the procedure, and thus indirectly increases the costs associated with using these measures. There is no advantage, per se, to using MIPS measures over QCDR measures.

ABG QCDR Measures

ABG 1

Intraoperative anesthesia safety

Percentage of patients with no significant anesthesia adverse events in the operating room/procedure room.

ABG 7*

Immediate adult post-operative pain management

The percentage of patients 18 or older admitted to the PACU after an anesthetic with a maximum pain score of 7/10 within 15 minutes of arrival prior to anesthesia end time.

ABG 16

Planned use of difficult airway equipment

For all patients on whom difficult airway equipment is used in the operating room/procedure room during an anesthetic, the rate with which it’s use is planned ahead of time for either therapeutic or educational purposes. The definition of difficult airway equipment for this measure excludes stylets and/or bougies unless they have been modified to include a light source or some other mechanical addition to manipulate their placement.

ABG 21

Pre-op OSA assessment

Percentage of patients who undergo a procedure in the operating room/procedure room that have a pre-operative assessment for Obstructive Sleep Apnea (OSA). Patients with ASA 5 or higher, history of OSA, on CPAP, ventilated/intubated, or otherwise unable to answer assessment questions are evaluated as denominator exceptions.

ABG 28*

Pre-op screening for GERD

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about symptoms of Gastroesophageal Reflux Disease during their pre-anesthetic evaluation.

ABG 29*

Pre-op screening for Glaucoma

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about a history of Glaucoma or elevated eye pressures during their pre-anesthetic evaluation.

ABG 30*

Pre-op screening for PONV risk

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about Post-operative Nauesa and Vomiting risk factors during their pre-anesthetic evaluation.

ABG 31*

Pre-operative screening for excessive alcohol and recreational drug use

Percentage of patients that undergo an anesthetic in the operating room/procedure room who are questioned about alcohol and recreational drug use during their pre-anesthetic evaluation.

ABG 36*

Corneal abrasion

(Formerly ABG 14) Percentage of patients having an anesthetic in the operating room/procedure room who experience any ocular surface injury requiring evaluation, follow up, or treatment within hours 24 hours of anesthesia end time.

*Graphium data entry tools and reporting mechanisms support the 6 fields highlighted in yellow. Every year we reassess all available measures and choose the best measures so your providers may earn the highest Composite Performance Score possible.

ABG Shared QCDR Measure

AQI 48

Patient-reported experience with anesthesia

Percentage of patients who are provided with a patient survey to provide feedback about their anesthesia experience and the percentage of patients who reported a positive experience.

MIPS Measures

MIPS 44

Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery

Percentage of isolated Coronary Artery Bypass Graft (CABG) surgeries for patients aged 18 years and older who received a beta-blocker within 24 hours prior to surgical incision.

MIPS 76

Prevention of Central Venous Catheter (CVC) – Related Bloodstream Infections

Percentage of patients, regardless of age, who undergo central venous catheter (CVC) insertion for whom CVC was inserted with all elements of maximal sterile barrier technique, hand hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed.

MIPS 130

Documentation of Current Medications in the Medical Record

Percentage of visits for patients aged 18 years and older for which the eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosage, frequency and route of administration.


MIPS 404

Anesthesiology smoking abstinence

The percentage of current smokers who abstain from cigarettes prior to anesthesia on the day of elective surgery or procedure.


MIPS 424

Perioperative temperature management

Percentage of isolated Coronary Artery Bypass Graft (CABG) surgeries for patients aged 18 years and older who received a beta-blocker within 24 hours prior to surgical incision.


MIPS 426

Post-Anesthetic Transfer of Care Measure: Procedure Room to a Post Anesthesia Care Unit (PACU)

Percentage of patients, regardless of age, who are under the care of an anesthesia practitioner and are admitted to a PACU in which a post-anesthetic formal transfer of care protocol or checklist which includes the key transfer of care elements is utilized.


MIPS 427

Post-Anesthetic Transfer of Care: Use of Checklist or Protocol for Direct Transfer of Care from Procedure Room to Intensive Care Unit (ICU)

Percentage of patients, regardless of age, who undergo a procedure under anesthesia and are admitted to an Intensive Care Unit (ICU) directly from the anesthetizing location, who have a documented use of a checklist or protocol for the transfer of care from the responsible anesthesia practitioner to the responsible ICU team or team member.


MIPS 430

Prevention of Post-Operative Nausea and Vomiting (PONV) – Combination Therapy

Percentage of patients, aged 18 years and older, who undergo a procedure under an inhalational general anesthetic, AND who have three or more risk factors for post-operative nausea and vomiting (PONV), who receive combination therapy consisting of at least two prophylactic pharmacologic antiemetic agents of different classes preoperatively or intraoperatively.

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MACRA compliance for Anesthesia quickly gets confusing and expensive to ignore. Our team would like to help you navigate these waters with confidence and success.

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2018 Anesthesia MACRA Compliance

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