Ndidi Ogechi Ivy Abara

Geriatric Medicine Yuma Regional Medical Center NPI1295115145

Performance

Public Reporting for Performance Scores

More Details

Final MIPS Score

100 out of 100

Score Breakdown

Quality Category Score 100
PI Category Score 100

 

IA Category Score 40
Cost Category Score 0
Total Patients: 28
Source of Scores: individual

Performance Details

Measure Code Measure Title Performance Rate Patient Count Star Value Five Star Benchmark Collection Type
IA_EC_AHE_5 MIPS Eligible Clinician Leadership in Clinical Trials or CBPR
IA_EC_AHE_6 Provide Education Opportunities for New Clinicians
IA_EC_BE_22 Improved Practices that Engage Patients Pre-Visit
IA_EC_BE_13 Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.
IA_EC_BE_4 Engagement of patients through implementation of improvements in patient portal
IA_EC_CC_11 Care transition standard operational improvements
IA_EC_BMH_4 Depression screening
IA_EC_CC_8 Implementation of documentation improvements for practice/process improvements
IA_EC_CC_13 Practice Improvements for Bilateral Exchange of Patient Information
IA_EC_EPA_1 Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record
IA_EC_PM_2 Anticoagulant Management Improvements
IA_EC_EPA_5 Participation in User Testing of the Quality Payment Program Website (https://qpp.cms.gov/)
IA_EC_PM_17 Participation in Population Health Research
IA_EC_PM_21 Advance Care Planning
IA_EC_PSPA_19 Implementation of formal quality improvement methods, practice changes, or other practice improvement processes
IA_EC_PSPA_2 Participation in MOC Part IV
IA_EC_PSPA_20 Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes
IA_EC_PSPA_16 Use of decision support and standardized treatment protocols
IA_EC_PSPA_29 Consulting AUC Using Clinical Decision Support when Ordering Advanced
MIPS_EC_001_overall Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 17 476 EHR
IA_EC_PSPA_6 Consultation of the Prescription Drug Monitoring Program
MIPS_EC_009_>=180Days Anti-Depressant Medication Management 85 34 EHR
MIPS_EC_009_>=84Days Anti-Depressant Medication Management 85 34 EHR
MIPS_EC_007_overall Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%) 86 22 EHR
MIPS_EC_112_overall Breast Cancer Screening 72 593 4 93 EHR
MIPS_EC_107_overall Adult Major Depressive Disorder (MDD): Suicide Risk Assessment 0 108 1 89 EHR
MIPS_EC_111_overall Pneumococcal Vaccination Status for Older Adults 73 989 3 98 EHR
MIPS_EC_110_overall Preventive Care and Screening: Influenza Immunization 54 2014 3 85 EHR
MIPS_EC_113_overall Colorectal Cancer Screening 49 1091 3 92 EHR
MIPS_EC_117_overall Diabetes: Eye Exam 16 476 1 100 EHR
MIPS_EC_119_overall Diabetes: Medical Attention for Nephropathy 92 476 4 100 EHR
MIPS_EC_130_overall Documentation of Current Medications in the Medical Record 96 3837 4 100 EHR
MIPS_EC_134_overall Preventive Care and Screening: Screening for Depression and Follow-Up Plan 0 1692 1 96 EHR
MIPS_EC_143_overall Oncology: Medical and Radiation Pain Intensity Quantified 0 20 1 100 EHR
MIPS_EC_236_overall Controlling High Blood Pressure 58 1107 EHR
MIPS_EC_226_screenedForUse Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 100 935 EHR
MIPS_EC_309_overall Cervical Cancer Screening 43 789 2 98 EHR
MIPS_EC_226_overall Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 59 106 3 100 EHR
MIPS_EC_239_BMI Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 100 167 EHR
MIPS_EC_239_nutrition Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 25 167 EHR
MIPS_EC_226_tobacco Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 95 935 EHR
MIPS_EC_305_14DaysOfDiagnosis Initiation and Engagement of Alcohol and Other Drug Dependence Treatment 3 30 EHR
MIPS_EC_281_overall Dementia: Cognitive Assessment 0 33 1 94 EHR
MIPS_EC_238_overall Use of High-Risk Medications in Older Adults 12 989 3 100 EHR
MIPS_EC_310_overall Chlamydia Screening for Women 33 82 EHR
MIPS_EC_239_physicalActivity Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents 29 167 EHR
MIPS_EC_317_overall Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 28 1966 2 64 EHR
MIPS_EC_305_30DaysOfVisit Initiation and Engagement of Alcohol and Other Drug Dependence Treatment 0 30 EHR
MIPS_EC_374_overall Closing the Referral Loop: Receipt of Specialist Report 23 263 2 88 EHR
MIPS_EC_318_overall Falls: Screening for Future Fall Risk 22 989 1 100 EHR
MIPS_EC_379_overall Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists 0 271 EHR
MIPS_EC_472_overall Appropriate Use of DXA Scans in Women Under 65 Years Who Do Not Meet the Risk Factor Profile for Osteoporotic Fracture 0 198 EHR
PI_EC_EP_1 e-Prescribing 100 581 5 100 EHR
MIPS_EC_475_overall HIV Screening 15 1676 2 33 EHR
PI_EC_EP_2 Query of the Prescription Drug Monitoring Program (PDMP)
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 100 1026 5 99 EHR
PI_EC_PHCDRR_2 Syndromic Surveillance Reporting
PI_EC_PHCDRR_1 Immunization Registry Reporting
PI_EC_PHCDRR_5 Clinical Data Registry Reporting
PI_EC_PHCDRR_4 Public Health Registry Reporting
PI_EC_PPHI_1 Security Risk Analysis