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Performance Categories & Scoring

Quality

Promoting Interoperability

Improvement Activities

Cost (Begins 2018)

The QUALITY component of the MIPS reporting program replaces the Physician Quality Reporting System (PQRS). Clinicians will be reporting in a similar fashion, on 6 quality measures, either as individuals or groups.
The PROMOTING INTEROPERABILITY category, previously called (Advancing Care Information) replaces the Medicare EHR Incentive Program. It is designed to promote efficient care with the support of technology. The PI category requires eligible clinicians to report on mandatory base score measures in order to receive credit. Clinicians are encouraged to report on performance as well as bonus score measures in order to maximize their scores.
The IMPROVEMENT ACTIVITIES category is new in the MIPS program, and was designed to promote engagement in clinical activities as well as improvement in the quality of care delivered. Eligible clinicians will choose a combination of various high and medium weighted activities in order to meet the requirements.
The COST category replaces the Value-Based Payment Modifier and is designed to gauge the total cost of care during the year or during a hospital stay. The cost of the care provided will be calculated by CMS based on Medicare claims. Eligible clinicians are NOT required to submit any data to CMS for this category.

Quality - 50%

  • Must choose 6 measures to report, or a specialty measure set, for a Full Year
  • No domain requirements
  • Must choose AT LEAST 1 outcome measure
    • If no outcome measure is applicable, must choose 1 high priority measure
  • 248 registry measures to choose from
  • 60% reporting threshold for 2018

  • Total points possible: 50
  • Performance deciles range from 3 points to 10 points
  • Measures are scored relative to their benchmarks
  • If no benchmark exists for scoring, the measure will receive 3 points
  • Quality measures that do not meet data completeness requirements (60% for 2018) will receive 1 point
  • Exception: Small practices (15 or fewer eligible clinicians) would receive 3 points
  • Bonus points can be achieve through CAHPS and high priority measures based on improvement from 1 year to the next (earn up to 10% points)
  • 0 points will be awarded for poor performance that falls below the first decile

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Promoting Interoperability - 25%

  • Required to use certified EHR technology (either 2014 or 2015)
  • Choose to report customizable measures to reflect how they use the technology
  • Must report on all base score measures (4 or 5, depending on CEHRT), for a minimum of 90 days
  • To maximize score, report on performance and bonus measures
  • Visit list of Promoting Interoperability measures – https://qpp.cms.gov/measures/aci
  • Available Hardship Exemption Application (due December 31, 2018)

  • Total points possible: 165 (any score above 100 will be capped at 100)
  • Base Score: 50, Performance Score: 90, Bonus Score: 25
  • 100% will equate to the full 25 MIPS percentage points
  • Reporting on all the required base score measures will award clinicians 50 points

The following clinicians are subject to an automatic re-weighting for PI:

  • Hospital-Based
  • Ambulatory Surgical Center (ASC)
  • Physician Assistants
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anethetists
  • Clinicians who lack face-to-face interactions with patients

Improvement Activities - 15%

  • Attest by indicating “yes” or 1 patient, to each activity that meets the 90-day requirement
  • Select activities that match practice goals
  • Select a combination of high and medium weighted activities
  • 112 activities to choose from in 9 subcategories

  • Activities are categorized by weight as either ‘medium’ or ‘high’
  • Patient Centered Medical Home practices will automatically receive full credit for this category

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Cost - 10%

  • Calculated by CMS on administrative claims data IF the case minimum of attributed patients is met
  • Cost category will be calculated from the average of the following:
    • Medicare Spending per Beneficiary (MSPB)
    • Total per Capita Cost Measures (TPCC)

  • CMS will assign 1 to 10 points to each measure (Total Per Capita Cost measure and Medicare Spending Per Beneficiary measure)
    • Total possible points available for each measure: 10 points

If the case minimum is not met for either of the Cost measures, the cost category will be reweighted to the Quality performance category.

  • Case minimum of attributed beneficiaries:
    • 20 cases for total per capita cost measure or 35 cases for medicare spending per beneficiary measure

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