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Performance Categories & Scoring

Quality

Promoting Interoperability

Improvement Activities

Cost

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 the required measures or claim the exclusions if applicable. Clinicians are encouraged to report on bonus measures in order to maximize their scores.
The IMPROVEMENT ACTIVITIES category 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 - 45%

  • 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
  • 257 registry measures to choose from
  • 60% reporting threshold for 2019

  • Total points possible: 45
  • 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 2019) 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%

  • To maximize score and earn full credit for PI, report on bonus measures
  • The scores for the measures will be determined by the performance rates
  • Score Breakdown: The total possible points are 110 with:
    • Measures Score: 100 points
    • Bonus Score: 10 points
  • Clinicians can earn bonus percentages points by the following:
    • Query of Prescription Drug Monitoring Program (PDMP)
    • Verify Opioid Treatment Agreement

Note: Points will be capped at 100 points, which equate the achieving a full 25% for the PI category score.

*In order to receive full credit for the category, clinicians must submit a yes for the security risk analysis and report on all of the required measures form each of the 4 objectives. When you report on required measures that have a numerator/denominator, you have to submit at least a 1 in the numerator if you do not claim an exclusion.

 

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

  • Hospital-Based
  • Ambulatory Surgical Center (ASC)
  • Physician Assistant
  • Nurse Practitioners
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anethetists
  • Clinicians who lack face-to-face interactions with patients
  • Physical Therapists
  • Occupational Therapists
  • Qualified Speech-Language Pathologists
  • Qualified Audiologists
  • Clinical Psychologists
  • Registered Dieticianor Nutrition Professionals

Click here to verify a clinician’s participation status

*If exempt from the PI category, the Quality category will be re-weighted to 70% of the final score.

 

Clinicians may apply for the PI category score to be re-weighted, for one of the following specified reasons:

  • Insufficient Internet Connectivity
  • Extreme and Uncontrollable Circumstances (Disaster, Practice Closure, Sever Financial Distress, or Vendor Issues)
  • Lack of Control over the Availability of CEHRT
  • Using Decertified EHR Technology
  • MIPS eligible clinicians in small practices
  • MIPS eligible clinicians using decertified EHR technology

Click here to access the CMS application for re-weighting.

*The Hardship Exception Application must be submitted by December, 31, 2019*

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
  • 118 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 - 15%

  • 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)
    • 8 Episode-Base Measures (New for 2019)

*If only one measure can be scored, that score will be the performance category score.

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
    • 10 Cases for Procedural Episodes
    • 20 Cases for Acute Inpatient Medical Condition Episodes

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