Quality Scoring Logic

CMS has updated the Quality category scoring logic for 2020. Some of the key changes to MIPS quality category scoring logic are

60 or 70 Max points

45% of final score

Select 6 of 200 and more Quality Measures as finalized for 2020 MIPS performance period.

For MIPS Submission at least One Quality measure must be Outcome Measure or High Priority Measure.
Outcome/High Priority measures are either of the following types – Appropriate Use measure, Patient experience, Patient safety, Efficiency measures, Care coordination or opioid-related quality measure.

* The Quality performance category has 1 measure, the All-Cause Hospital Readmission measure, that’s evaluated by administrative claims. Groups and virtual groups, with 16 or more clinicians, are automatically subject to the All-Cause Hospital Readmission measure if they meet the case minimum of 200 patients for the measure. Beginning in 2018, MIPS eligible clinicians will be able to report for new as well as modified MIPS quality measures and specialty measure sets.
Provider can choose to submit the same measure across different collection types to optimize his/her achievement score for the measure.

Bonus Points : Clinicians receive bonus points for each of the following

Submitting an additional High-priority Measure

2 Bonus points for each additional Outcome and Intermediate Outcome measure.

1 Bonus point for each additional High-priority Measure

Using CEHRT to submit measures to CMS electronically

1 Bonus point for end- to- end electronic data submission.

Small Practice Bonus

The small practice bonus will now be added to the Quality performance category, rather than in the MIPS final score calculation

6 bonus points are added to the numerator of the Quality performance category for MIPS eligible clinicians in small practices who submit data on at least 1 quality measure.

Submitting an additional High-priority Measure

2 Bonus points for each additional Outcome and Patient experience measure

1 Bonus point for each additional High-priority Measure

Using CEHRT to submit measures to registers or CMS

1 Bonus point for end- to- end electronic data submission.

Small Practice Bonus

The small practice bonus will now be added to the Quality performance category, rather than in the MIPS final score calculation

6 bonus points are added to the numerator of the Quality performance category for MIPS eligible clinicians in small practices who submit data on at least 1 quality measure.

Improvement percent score

For 2020, improvement in the Quality performance category will be scored and this improvement score will be included in calculating the quality performance category score. Improvement score is capped at 10% in Quality category

Topped out measures

Special scoring cap of 7 points is applied to the measures identified as Topped Out for the performance year 2020.

Total Quality Performance Category Score
=
Total points earned on required 6 Quality Measures
+
Measure Bonus points (Including Small Practice Bonus if applicable)
Maximum number of points*
+
Improvement percent score**

Quick tip: Maximum Score cannot exceed 100%
*Maximum Number of Points = # of Required Measures x 10