In 2020, more than 20,500 emergency department clinicians (70 percent of whom are emergency physicians) utilized ACEP’s Clinical Emergency Data Registry (CEDR) to report on their quality performance. When the Centers for Medicare & Medicaid Services (CMS) recently released its analysis of the Merit-based Incentive Payment System (MIPS) for 2020, there was a great deal of pride in how CEDR participants performed:

• 100 percent of emergency physician CEDR participants achieved a MIPS bonus payment.
• 92 percent met the exceptional performance threshold (significant bonus increase).
• 22 percent earned a perfect MIPS score (estimated $1,683 bonus per physician).

CEDR provides an advantage for its participants by providing EM-specific measures that are not accessible through non-EM quality registries. For example, while CMS offers sinusitis, upper respiratory infections, and bronchitis measures of little importance to emergency care and in which comparisons to non-emergency physicians may be inadequate, CEDR offers measures specific to EM and emergency care on conditions such as sepsis, pulmonary embolism, and chest pain. The custom measures that come with CEDR maximize the potential for positive payment adjustments; groups reporting on EM-specific measured performed on average 19 percent better than those reporting on public domain measures offered by CMS.

These bonus payments based on 2020 performance will be applied to 2022 Medicare reimbursements. Due to the overwhelming disruption of operations due to the COVID-19 pandemic in 2020, CMS only offered a (very modest) maximum bonus of 1.87 percent. This is very important to all emergency physicians because  the current proposed final rule indicates that the maximum bonus for 2022 may be as high as 12 percent. 

Looking ahead, CMS has already announced that it anticipates applying penalties to half the physicians in the United States next year. CEDR is here to help emergency physicians avoid that fate (no emergency physicians enrolled in CEDR were penalized by CMS in 2020) by providing support and resources that help ACEP members thrive in quality reporting. Remaining on the bonus side of the MIPS program is essential as ACEP continues fighting against cuts in reimbursement in other domains, such as evaluation and management codes.

By the numbers:

100% of emergency physician CEDR participants achieved a MIPS bonus payment.

92% met the exceptional performance threshold (significant bonus increase).

22%earned a perfect MIPS score—estimated  $1,683 bonus per physician.

Learn more about CEDR and become part of the ACEP drive for high-quality care. To do a deeper dive into MIPS, check out the ACEP Frontline podcast on this topic (Sept. 13) or watch the free on-demand webinar “Future of MIPS Reporting – Navigating Through Uncharted Waters” in the Online Learning Center.

CEDR is just one example of how ACEP data and quality improvement efforts help guide EM practice. CEDR data work in concert with ACEP’s Emergency Quality Network (E-QUAL) to provide insights on best practices and outcomes. Where CEDR is focused on discrete data and alignment with quality measures, E-QUAL strives for higher-level focus on quality improvement, education/toolkit dissemination, and alignment with CMS improvement activities.

For example, in 2017, the E-QUAL Sepsis Initiative surveyed 50 emergency departments to assess compliance with the Severe Sepsis and Septic Shock: Early Management Bundle (SEP-1). Those data showed the bundle didn’t fit current EM practice and helped form the evidence for ACEP’s decision to use its quality data to push back on SEP-1.