The Healthmonix Advisor

Improvement Provision for Quality and Cost Measures

Posted by Lauren Patrick on February 22, 2018

In year two of MIPS and beyond, CMS is including an Improvement score for Quality and Cost measures. This week we take a deep dive into what this score entails, as well as what you need to know to keep yours ahead of the curve.

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How will improvement be scored?

The following summarized from the CMS 2018 Final Rule. Under MACRA, improvement scoring is available to MIPS-eligible clinicians and groups that demonstrate improvement in performance in the current MIPS performance period compared to their performance in the immediately preceding MIPS performance period. There will be two different approaches for scoring improvement from year to year for quality and for cost: Quality will be measured at the performance category level, while cost will be measured at the measure level.

 

How could my Quality score be affected?

Improvement scoring for the Quality category is based on the rate of improvement, where higher improvement results in more points for those who have not previously performed well. The score that represents improvement for the purposes for calculating the quality performance category percent score is called the improvement percent score. To determine the improvement percent score, CMS will compare the current MIPS performance period quality performance category achievement percent score to the previous performance period quality performance category achievement percent score. If the current score is higher, and if the clinician meets all other qualifications, the improvement percent score may be added into the quality performance category percent score for the current performance year.

For the 2018 MIPS performance period, a 3-point floor will be applied for each measure that can be reliably scored against a benchmark based on the baseline period. As with bonuses available in the quality performance category, the improvement percent score is capped at a maximum of 10 percentage points. However, if a given MIPS-eligible clinician did not fully participate in the quality performance category for the current performance period, the improvement percent score will be set to zero.

The improvement percent score is calculated by the following formula:

Improvement percent score = (increase in quality performance category achievement percent score from prior performance period to current performance period/prior year quality performance category achievement percent score) * 10 percent.

In this formula, a full score of 10 percentage points represents 100 percent improvement over the preceding period. The improvement score cannot be a negative number.

Once the improvement percent score is determined, the Quality performance category percent score will then be calculated as follows (not to exceed 100 percent):

Quality performance category percent score = ([total measure achievement points + measure bonus points] / total available measure achievement points) + (improvement percent score)

The below table shows how improvement percent scores would be calculated for individual eligible clinicians in various circumstances:

  2017 Quality Performance Category Score 2018 Quality Performance Category Score Increase in achievement Rate of improvement Improvement percent score
Individual Eligible Clinician #1 (Pick your Pace Test Option) 5% (Will substitute 30% which is the lowest score a clinician can achieve with complete reporting in year 1.) 50 20% Because the year 1 score is below 30%, we measure improvement above 30% 20%/30%= 0.67 0.67*10% = 6.7% No cap needed.
Individual Eligible Clinician #2 60% 66 6% 6%/60%= 0.10 0.10*10% = 1.0% No cap needed.
Individual Eligible Clinician #3 90% 93 3% 3%/90%= 0.033 0.033*10% = 0.3% No cap needed.
Individual Eligible Clinician #4 30% 70 40% 40%/30%=1.33 1.33*10%=13.3% Apply cap at 10%.

 

How could my Cost score be affected?

Improvement scoring for the Cost category is based on statistically significant changes at the measure level. In the case of the cost performance category, your MIPS final score for the 2018 performance period will not be affected by the improvement score. This cost improvement score is weighted at 0%, and is for informational purposes only.

The Cost improvement score is calculated only when data sufficient to measure improvement is available. CMS considers data sufficient when a MIPS eligible clinician participates in MIPS using the same identifier in 2 consecutive performance periods and is scored on the same cost measure(s) for 2 consecutive performance periods. If the data is insufficient to calculate the cost improvement score, then the score assigned will be zero percentage points.

The Cost improvement score is calculated by the following formula:

Cost improvement score = ([number of cost measures with significant improvement] - [number of cost measures with significant declines]) / (number of cost measures for which the MIPS eligible clinician or group was scored in both performance periods) * (maximum cost improvement score)

Once the Cost improvement score is determined, the Cost performance category percent score will then be calculated as follows:

Cost performance category percent score = (Cost Achievement Points / Available Cost Achievement Points) + (Cost Improvement Score)

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Topics: MIPS, Quality Performance Category, Cost Performance Category