Ms. Andrea Marie Cantwell-Durand

Family Watertown Memorial Hospital NPI1396921375

Performance

Public Reporting for Performance Scores

More Details

Final MIPS Score

100 out of 100

Score Breakdown

Quality Category Score 100
PI Category Score 0

 

IA Category Score 40
Cost Category Score 0
Total Patients: 23
Source of Scores: individual

Performance Details

Measure Code Measure Title Performance Rate Patient Count Star Value Five Star Benchmark Collection Type
IA_EC_BE_4 Engagement of patients through implementation of improvements in patient portal
IA_EC_BMH_2 Tobacco use
IA_EC_BMH_4 Depression screening
IA_EC_CC_13 Practice Improvements for Bilateral Exchange of Patient Information
IA_EC_PM_16 Implementation of medication management practice improvements
IA_EC_PSPA_16 Use of decision support and standardized treatment protocols
IA_EC_PSPA_18 Measurement and Improvement at the Practice and Panel Level
IA_EC_PSPA_21 Implementation of fall screening and assessment programs
MIPS_EC_001_overall Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 28 67 EHR
MIPS_EC_107_overall Adult Major Depressive Disorder (MDD): Suicide Risk Assessment 0 33 1 89 EHR
MIPS_EC_110_overall Preventive Care and Screening: Influenza Immunization 34 434 2 85 EHR
MIPS_EC_117_overall Diabetes: Eye Exam 28 67 2 100 EHR
MIPS_EC_112_overall Breast Cancer Screening 62 169 3 93 EHR
MIPS_EC_128_overall Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 20 406 1 98 EHR
MIPS_EC_113_overall Colorectal Cancer Screening 67 266 3 92 EHR
MIPS_EC_119_overall Diabetes: Medical Attention for Nephropathy 81 67 4 100 EHR
MIPS_EC_130_overall Documentation of Current Medications in the Medical Record 92 855 4 100 EHR
MIPS_EC_134_overall Preventive Care and Screening: Screening for Depression and Follow-Up Plan 46 424 2 96 EHR
MIPS_EC_226_overall Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 33 45 2 100 EHR
MIPS_EC_226_screenedForUse Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 75 481 EHR
MIPS_EC_236_overall Controlling High Blood Pressure 76 204 EHR
MIPS_EC_309_overall Cervical Cancer Screening 39 209 2 98 EHR
MIPS_EC_226_tobacco Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 69 481 EHR
MIPS_EC_318_overall Falls: Screening for Future Fall Risk 63 174 3 100 EHR
MIPS_EC_238_overall Use of High-Risk Medications in Older Adults 6 174 4 100 EHR
MIPS_EC_317_overall Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 34 430 3 64 EHR
MIPS_EC_374_overall Closing the Referral Loop: Receipt of Specialist Report 29 221 2 88 EHR