Margaret A Bisceglia

Women's Health Beaufort County Memorial Hospital NPI1942260153

Performance

Public Reporting for Performance Scores

More Details

Final MIPS Score

82.59 out of 100

Score Breakdown

Quality Category Score 81.80
PI Category Score 68

 

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

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_21 Implementation of fall screening and assessment programs
IA_EC_PSPA_16 Use of decision support and standardized treatment protocols
MIPS_EC_110_overall Preventive Care and Screening: Influenza Immunization 18 527 1 85 EHR
MIPS_EC_113_overall Colorectal Cancer Screening 70 27 4 92 EHR
MIPS_EC_112_overall Breast Cancer Screening 65 26 3 93 EHR
MIPS_EC_128_overall Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 28 315 2 98 EHR
MIPS_EC_130_overall Documentation of Current Medications in the Medical Record 99 1341 4 100 EHR
MIPS_EC_134_overall Preventive Care and Screening: Screening for Depression and Follow-Up Plan 10 726 1 96 EHR
MIPS_EC_226_overall Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 37 38 2 100 EHR
MIPS_EC_226_screenedForUse Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 94 812 EHR
MIPS_EC_226_tobacco Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 92 812 EHR
MIPS_EC_236_overall Controlling High Blood Pressure 70 33 EHR
MIPS_EC_317_overall Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 83 1276 5 64 EHR
MIPS_EC_309_overall Cervical Cancer Screening 92 621 4 98 EHR
PI_EC_EP_1 e-Prescribing 99 1104 4 100 EHR
PI_EC_LVITC_2 Support Electronic Referral Loops By Receiving and Reconciling Health Information Exclusion
PI_EC_LVOTC_1 Support Electronic Referral Loops By Sending Health Information Exclusion
PI_EC_ONCACB_1 ONC-ACB Surveillance Attestation
PI_EC_ONCDIR_1 ONC Direct Review Attestation
PI_EC_PEA_1 Provide Patients Electronic Access to Their Health Information 88 948 4 99 EHR
PI_EC_PHCDRR_4 Public Health Registry Reporting
PI_EC_PHCDRR_5 Clinical Data Registry Reporting
PI_EC_PPHI_1 Security Risk Analysis