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Quality Scoring Logic

CMS has updated the Quality category scoring logic for 2019. Some of the key changes to MIPS quality category scoring logic are

60 or 70% Max points

45% of final score

Select 6 of 300 and more Quality Measures as finalized for 2019 MIPS performance period
(For a full performance year to be eligible for payment adjustment);1 must be:

Outcome Measure or High Priority Measure – defined as Outcome measure, Appropriate Use measure, Patient experience, Patient safety, Efficiency measures, Care coordination, or opioid-related quality measure.

* The all-cause readmission measure is not submitted and applies to all groups of 16 or more clinicians who meet the case minimum of 200. 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

01
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
02
Using CEHRT to submit measures to registers or CMS
1 Bonus point for end- to- end electronic data submission.
03
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.

01
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
02
Using CEHRT to submit measures to registers or CMS
1 Bonus point for end- to- end electronic data submission.
03
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 2019, 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 6 measures identified as Topped Out for the performance year 2019.

  • 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**

category score

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

**Improvement scoring at Quality performance category level will be included when data is sufficient.