The MIPS Quality Performance Category is replacing PQRS reporting in 2017, folding it into the Merit-Based Incentive Payment System. The Quality portion will comprise 60% of an eligible clinician's MIPS Composite Performance Score for 2017.  To calculate that score, there is significant math involved.  This article will walk you though the calculations and logic used to determine your Quality score, but it is important to note that many data submission vendors will automatically give you a predictive calculation.

Performance Data Review

Each previously utilized measure has been reviewed for benchmarks from data gathered from a prior performance period.  CMS has gathered that data and analyzed it in terms of reliability.

Decile Determination

If a measure has sufficient data, CMS has determined deciles based on that data.  They have analyzed the range for the top 10% of providers and that is Decile 10.  Then they have pulled the performance metrics for the next 10% of providers and that range is Decile 9.  And the next 10% of providers determined decile 8, and so on. 

Points per Decile

For each individual clinician or group, points will be awarded for each measure with at least 20 cases submitted based on where the provider’s performance score falls as follows.  If the provider has less than 20 cases, 3 points will be awarded. It is important to note that for the 2017 performance period, zero points will only be awarded for a measure if it is not reported at all.

Table One: Quality Deciles and Point Allocation                     

Measures with No Benchmarks

For measures with no historic benchmark, CMS will attempt to calculate benchmarks based on 2017 performance data after data is submitted. Benchmarks are created if there are at least 20 reporting clinicians or groups that meet the criteria for contributing to the benchmark, including meeting the minimum case size (which is generally 20 patients), meeting the data completeness criteria, and having performance greater than 0 percent (less than 100 percent for inverse measures). If no historic benchmark exists and no benchmark can be calculated, then the measure will receive 3 points.

Tenths of Points

If a measure performance rate lies within a benchmark decile rather than on a decile boundary, then a linear interpolation is done to determine the quality point value between the decile boundaries to the nearest tenth of a point.

More than Six Measures

If more than six measures are submitted, CMS will use the top six measures’ scores. This gives providers an opportunity to over-report without worrying about damaging their MIPS Composite Performance Score, and actually providing incentive to track more than the minimum required number of measures.

Bonus Points

The Quality Performance Category offers options for increasing a provider’s score.  Bonus points can be earned by submitting extra outcome or high priority measures (2 points for each additional outcome measure and 1 point for each additional high priority measure).  In addition, if the provider submits data via end-to-end electronic technology, an additional 1 point per measure will be awarded (up to 10 percent).

Additional Measure

If a practice is comprised of 16 or more eligible providers, CMS will calculate the All-Cause Hospital Readmission measure from the claims submitted for the year. This calculation is then added to the calculations for the MIPS Advancing Care Information and Improvement Activities component to determine the final MIPS score.  Once the MIPS score is determined, it will be compared to the other MIPS scores achieved during the year and a reimbursement adjustment will be determined.