Performance Categories

Each clinician or group will have a MIPS composite performance score (CPS) which incorporates 4 weighted performance categories on a 0-100 point scale. The four performance categories include:


*Small practices with ≤15 clinicians that submit data on at least one performance category are automatically awarded five bonus points


  Quality

Quality Measures

The Quality Measures category of MIPS replaces the Physician Quality Reporting System (PQRS) and will contribute to 50% of a provider's MIPS Final Score in 2018, unless a provider is a part of an APM.

There are a total of 271 quality measures for 2017. CMS requires reporting on a minimum of 6 measures; in order to optimize your opportunity for potential bonus points, HealthEC encourages providers to submit data on more than the minimum 6 measures.

Providers also have the option of choosing to report on a "Specialty Measure Set", however, HealthEC does not recommend this option because it requires reporting on every single measure within that set, and failing to so could dramatically impact your score. The following links provide further details on the quality measures for many of the Specialty Measure Sets:

*Please note: The measures identified in these specialty lists are not inclusive of the non-specialty measures. For a complete list of all measures, specialty or otherwise, please refer to: https://qpp.cms.gov/mips/quality-measures.

  Promoting Interoperability(PI)

Providers earn points toward their MIPS final score by attesting to measures in this new category related to meaningful use of their EHR.

Providers are required to use a certified (either 2014 or 2015) EHR technology; use this link to determine your EHR edition. You must report all base score measures (4 or 5, depending on your EHR) for a minimum of 90 days; to maximize your score, report on other measures.

The PI score has three components, with a maximum of 100 points:

  • Base Score
    • You must meet all 4 or 5 base score requirements to earn a base score of 50%
      • *If you cannot report all 4 or 5, then your score for the entire PI section is zero
  • Performance score
    • Measures are individually weighted
    • Your score for each measure is based on your performance, e.g. if your performance rate is 50% for a measure, then you earn half of the possible points for that measure.
  • Bonus score
    • If you participate in at least one registry beyond the immunization registry, you qualify for a 5% bonus
    • If you use a Certified Electronic Health Record Technology (CEHRT), you quality for a 10% bonus

HealthEC can supplement your PI activities if you are having difficulty calculating numerators/denominators in your EMR, sending or receiving patient care summaries, etc.

  Improvement Activities

In the Improvement Activities category, clinicians are rewarded for focusing on care coordination, beneficiary engagement, and patient safety.

Providers are required to earn 40 points, and can choose any combination of high-weight and medium-weight activities to total 40 points.

  • High weight activities = 20 points
  • Medium weight activities = 10 points

*If you are a part of a practice with 15 or fewer members, the improvement activities are re-weighted such that high weight activities are worth 40 points and medium weight activities are worth 20 points each.

  Cost

Cost comprises 10% of the final composite score for the MIPS 2018 reporting year.

The cost measure will be calculated using the Medicare Spending per Beneficiary (MSPB) and total per capita cost measures; these two measures have been carried over from the Value Modifier program.

Cost is calculated by comparing performance against benchmarks for the reporting year, and are assigned on a decile system; no action is required by clinicians to calculate or submit data about their cost of care. Since cost scoring is based on the MSPB and the total per capita costs for all attributed beneficiaries, this could have an enormous impact on the scores of clinicians who frequently prescribe expensive Part B drugs, such as ophthalmologists, rheumatologists and oncologists.

Background on Cost Calculations

Medicare Spending per Beneficiary (MSPB)

The numerator for a TIN's specialty-adjusted MSPB Measure is the TIN's average MSPB amount, which is defined as the sum of standardized, risk-adjusted spending across all of a TIN's eligible episodes, divided by the number of episodes for that TIN. This ratio is multiplied by the national average standardized episode cost.

An MSPB episode includes all Medicare Part A and Part B claims with a start date falling between 3 days prior to an Inpatient Prospective Payment System (IPPS) hospital admission (also known as the "index admission" for the episode) and 30 days after hospital discharge.

Total Per Capita Cost for All Attributed Beneficiaries

The outcome for this measure is the sum of Medicare Part A and Part B costs for each beneficiary. Costs are payment standardized, annualized, risk adjusted, and specialty adjusted.

The following CPT codes have been added to the program for purposes of calculating attributed beneficiaries in the total cost measure:

  • Transitional care management (CPT codes 99495 and 99496)
  • Chronic care management (CPT codes 99487 and 99489 and 99490)