Dr. Wael Al-Halaseh

Cardiovascular Disease Dekalb Regional Medical Center NPI1760645311

Performance

Public Reporting for Performance Scores

More Details

Final MIPS Score

99.84 out of 100

Score Breakdown

Quality Category Score 97.93
PI Category Score 85

 

IA Category Score 40
Cost Category Score 0
Total Patients: 139
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_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
MIPS_EC_001_overall Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) 72 535 EHR
MIPS_EC_007_overall Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%) 68 161 EHR
MIPS_EC_047_overall Advance Care Plan 1 1337 1 100 REG
MIPS_EC_128_overall Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan 23 2223 1 98 EHR
MIPS_EC_119_overall Diabetes: Medical Attention for Nephropathy 79 535 3 100 EHR
MIPS_EC_130_overall Documentation of Current Medications in the Medical Record 99 4597 4 100 EHR
MIPS_EC_226_overall Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 20 51 1 100 EHR
MIPS_EC_226_screenedForUse Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 20 1633 EHR
MIPS_EC_226_tobacco Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention 18 1633 EHR
MIPS_EC_236_overall Controlling High Blood Pressure 55 1700 EHR
MIPS_EC_238_overall Use of High-Risk Medications in Older Adults 0 1297 5 100 EHR
MIPS_EC_317_overall Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented 21 1995 2 64 EHR
MIPS_EC_374_overall Closing the Referral Loop: Receipt of Specialist Report 10 356 1 88 EHR
PI_EC_EP_1 e-Prescribing 98 4696 4 100 EHR
PI_EC_HIE_5 Health Information Exchange(HIE) Bi-Directional Exchange
PI_EC_ONCACB_1 ONC-ACB Surveillance Attestation
PI_EC_PEA_1 Provide Patients Electronic Access to Their Health Information 62 2295 3 99 EHR
PI_EC_ONCDIR_1 ONC Direct Review Attestation
PI_EC_PHCDRR_5 Clinical Data Registry Reporting
PI_EC_PHCDRR_4 Public Health Registry Reporting
PI_EC_PPHI_1 Security Risk Analysis