HealthEC Blog Posts

Going for the Gold: MIPS Quality Calculations and Olympic Figure Skating

In the spirit of the winter Olympic Games, where hard work and dedication can lead to a gold medal, let’s take a closer look at MIPS quality calculations, as these same traits can optimize a provider’s bonus for Performance Year 2018.

Not all Olympic athletes will medal and not all providers will qualify for the MIPS bonus. But both groups are expected to compete. (Providers, of course, get penalized if they don’t.)

And just as Olympians must have a solid understanding of what the judges are looking for in competition, providers should know what CMS is expecting from their performance reporting.

In figure skating, for example, where a triple axel is considered more difficult than a triple loop, a competitor may have skated a clean long program, but under the sport’s points system, competitors who fall down can still win if their program has a higher level of difficulty. Further, skaters can lose out by not incorporating enough jumps into their programs.

Reporting on MIPS quality measures is much the same. Each measure has its own calculations and is assigned a different weighting, and will therefore affect overall quality scores differently.

So, even if providers have a poor performance in a heavily weighted category like Preventive Care and Screening: Influenza Immunization (#110) via QCDR submission, their overall quality score could still be stronger than a solid performance in a less-weighted category, such as Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis (#116), or a measure without a benchmark, like Hemoglobin A1c Test for Pediatric Patients (#365).

And just like the skater not blending enough jumps into their performance, providers may get penalized for submitting data on fewer than six quality measures. In fact, CMS will conduct an eligible measure applicability (EMA) process to identify clinically-related measures providers could have submitted for, and should other measures be recognized, it could have major implications for the provider’s quality performance calculation and score.

CMS has also issued other quality rule changes that will impact scores in 2018 and beyond:

  1. The quality component - worth 50 percent of the final score this year - will be moved to 30 percent in 2019 and beyond.
  2. In 2017, providers had to submit data on at least 50 percent of the patient population applicable to each measure, but in 2018, at least 60 percent data completeness is required.

Further, providers should be aware of other key points when it comes to reporting quality measures:

  • In order for a measure to be considered “reliable” (per CMS), you must have 20 eligible cases for the measure, and you must submit data on at least 60 percent of your patient data for that measure. For example, if your denominator is 2,000, you must submit data for 60 percent or 1,200 patients.
  • For the quality score calculation (50 maximum points), CMS will only use your performance on the top six measures that you submit (there is no value in submitting more), and points are awarded based on a sliding scale specific to each measure. Additionally, submitting through a registry/QCDR (which CMS is pushing physicians to do) gives providers the opportunity to secure more points than using claims data or an EHR. See below.
    • In this example, a provider with 9.2% of patients in poor control of Hemoglobin A1C would be in the 8th decile (earning 8 points) if submitting using claims data, 7th decile (earning 7 points) if submitting using their EHR, and the 10th decile (earning 10 points) if submitting through a registry/QCDR.
    • Likewise, if a provider was 99% compliant with Colorectal Cancer Resection Pathology Reporting, they would be in the 4th decile if reporting through a registry/QCDR, but would not earn any points if submitting using claims data, and submitting using their EHR is not even an option.

    Mips Decile Table

  • Bonus points, earned on high-priority measures, can be used to make up points lost on the six reported measures. Overall, you can get up to 20 percent in bonus points (two bonus point for each outcome and patient experience measure, or one bonus point for each additional high-priority measure). For example, if you only get 10 points for all measures, you can earn two extra points (20 percent) as a bonus, and if you get 50 points for all six measures, you can earn 10 extra points as a bonus.

More than the thrill of victory or agony of defeat, MIPS scoring has an even bigger impact on providers: it could affect their livelihoods. CMS makes all MIPS scores public, and in an age where everything from skating rinks to Zambonis are rated online, providers should make every effort to make sure they score well.

Have questions about your 2018 MIPS reporting? HealthEC is ready to help! Please contact us at (732) 902-0070 or mips@healthec.com.

Jessica Kullman

Blogger Name: Jessica Kullman

Date of Publishing : February 20, 2018

About the Author : Jessica Kullman is the QCDR MIPS Program Manager for HealthEC