MIPS: An In-Depth look at the Quality Category

Posted on  July 12, 2017


The Quality Category of the MIPS Payment Track is the most important category overall. It counts for 60% of your Total Composite Performance Score, which is more than the other two categories combined. Because of this, it is imperative that you choose your measures carefully and understand how the category is scored so that you can perform to the best of your ability.

Most eligible clinicians know that they must report on six measures for this category. What you might not know is that beyond the six measures, CMS will be scoring you on another 2-3 population measures based on the size of your practice. Those with 10 or fewer eligible clinicians will be scored for two additional measures. Those with more than 10 eligible clinicians will be scored on three additional measures. Again, these are not measures that you report for. CMS calculates your score based on the claims data you send in.

First, let’s look at exactly how you will go about choosing the six measures you will report for. CMS has set up a search tool that is available for all eligible clinicians to use in order to choose the measures that are most relevant to your practice. Before you go to the site, here are the instructions on how to best use the tool.
Because you have 271 measures to choose from, CMS has provided three filters along with a keyword search available to help narrow down your options.

1. Specialty Measure Set Filter – CMS has identified 30 specialties and grouped together the measures that are most relevant to that specialty to make it much easier for those providers to choose the measures they will perform best for. For instance, if your specialty is cardiology, you can choose that filter and narrow the list of measures from 271 down to 20 measures, making it much easier to choose the six that you will perform well for.
2. Data Submission Method Filter – If you prefer a certain submission method over another, this will help you further narrow your list. The choices are:

  1. Administrative Claims
  2. Claims
  3. CSV
  4. CMS Web Interface
  5. HER
  6. Registry

Continuing with the Cardiology example, now that you narrowed the list from 271 to 20 you can narrow it even further by choosing a preferred submission method. For instance, if you choose to submit by “Claims,” the list of 20 will be pared down to 8. Once again, you have made it much easier to choose the 6 that are most relevant to your practice.
3. High Priority Measure Filter – This filter is important because CMS requires that at least one of your 6 measures be an outcome or “high-priority” measure. Use this filter to identify a high priority measure so you can ensure you have at least one of them in six measures you choose.
4. Keyword Search – Perhaps you are a podiatrist, chiropractor, or another specialty that was not included in the specialty measure set. If this is you, you can search by keyword. For instance, a podiatrist can choose to search using the keyword “foot.” This search will return three measures related to diabetic foot exams and a fourth measure that relates to the functional status change of a patient with foot or ankle impairments. Perhaps you will use the keyword “medication” and find the measures relating to documentation of current medications in the medical record. CMS made sure there were multiple broad measures like this one that could be used no matter what your specialty is.

To access the Quality Measure Search Engine click here: https://qpp.cms.gov/measures/quality.

So now that you have chosen the most relevant measures for your practice, let’s take a look at how you will be scored. The total score for this category can be 80 points for practices with 10 or fewer eligible clinicians or 90 points for practices with more than 10 eligible clinicians. Here’s how you achieve that score.

Each measure is worth 10 points. You will report for 6 measures which will give you up to 60 points depending on how well you performed for each measure. For practices with 10 or fewer clinicians, CMS will then score you on two additional population measures based on data they collect from your claims. These two additional measures are also worth 10 points each which will give you a total possible score of 80 points. For those practices with more than 10 clinicians, CMS will then score you on three additional population measures worth 10 points each giving you a total possible score of 90 points. Here is an example of a possible Quality Category Score for a practice with fewer than 10 eligible clinicians:
Measure 1 : 8 points
Measure 2 : 10 points
Measure 3 : 5 points
Measure 4 : 8 points
Measure 5 : 9 points
Measure 6 : 10 points
Population Measure : 8 points
Population Measure : 10 points

Total Score: 68 points out of 80 possible points = 85%

Remember, this category weighs 60% of your Total Composite Performance Score. Because this is the first Performance Year for the MIPS Payment Track, we don’t truly have anything to compare your score with until we know how everyone else has performed. However, CMS will be providing you with feedback at some point in 2018 after the reporting deadline has passed so that you will know what to expect for the first payment adjustment in 2019.

One final thing to note is that you will not, under any circumstance, receive a negative payment adjustment if you choose any of the three options available to you. However, if you choose the 90-day or the full-year reporting, you will be eligible to receive some sort of positive payment adjustment based on your score when compared to all other eligible clinicians in the MIPS Payment Track. Only those who choose not to participate will receive a negative payment adjustment of 4%. This will not hold true in future years but is an adjustment made for the first Performance Year.

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Comments 26

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