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2018 MIPS Performance Weightage

2018, being the second performance year of the MIPS rollout, CMS has now added 10% weight to the Cost category reducing 10% points form the Quality category, Weightage of the Quality category is reduced from 60% in 2017 to 50% in 2018. The weightage for PI and IA remain the same at 25% and 15% respectively.

Performance category

Performance Category

Quality Reporting Requirements

Criteria

MIPS Quality

Measure Group Submission

Measure group submission is not allowed, instead Physicians can use specialty measure sets to ensure simplicity in reporting.

Submission Eligibility

  • Eligible clinicians can submit from the specialty measure set.
  • Groups can also submit their applicable measure sets or select the best applicable measures.

Submission Criteria

  • Individuals and Groups have to report 6 measures including one outcome measure or a high priority.
  • If specialty specific measure set has fewer than 6 measures, eligible clinicians have to report for all the applicable measures.

Data Completeness Criteria

MIPS eligible clinicians have to submit data on at least 60 percent of the MIPS eligible clinicians or group’spatient’s data regardless of the payer.

Case Volume

Minimum 20 patients per measure is required.

Performance Criteria

  • Measures are scored based on the performance and benchmark and will qualify for 3 to 10 points same as transition year 2017.
  • Measures that are submitted and meet the data completeness criteria will qualify for 3 points under Quality performance category in 2018.
  • Measures submitted, but do not meet data completeness criteria, regardless of whether they have a benchmark or meet the case minimum will gain 1 point under Quality performance category in 2018.

Reporting Requirements

Quality Reporting Requirements

Criteria

MIPS Quality

Measure Group Submission

Measure group submission is not allowed, instead Physicians can use specialty measure sets to ensure simplicity in reporting.

Submission Eligibility

  • Eligible clinicians can submit from the specialty measure set.
  • Groups can also submit their applicable measure sets or select the best applicable measures.

Submission Criteria

  • Individuals and Groups have to report 6 measures including one outcome measure or a high priority.
  • If specialty specific measure set has fewer than 6 measures, eligible clinicians have to report for all the applicable measures.

Data Completeness Criteria

MIPS eligible clinicians have to submit data on at least 60 percent of the MIPS eligible clinicians or group’s patient’s data regardless of the payer.

Case Volume

Minimum 20 patients per measure is required.

Performance Criteria

  • Measures are scored based on the performance and benchmark and will qualify for 3 to 10 points same as transition year 2017.
  • Measures that are submitted and meet the data completeness criteria will qualify for 3 points under Quality performance category in 2018.
  • Measures submitted, but do not meet data completeness criteria, regardless of whether they have a benchmark or meet the case minimum will gain 1 point under Quality performance category in 2018.

PI Reporting Requirements

The CMS has made only a few changes to the MIPS PI Reporting Requirements for 2018. The key requirements for MIPS PI reporting requirements are as listed below:

In 2018, There are 2 measure set for reporting based on EHR edition:

Promoting Interoperability
Objectives & Measures

2017 Promoting Interoperability Transition
Objectives & Measures

PI Reporting Requirements

Promoting Interoperability

Replaces the Medicare EHR Incentive Program, also known as Meaningful Use.

Fulfill the required base measures for a minimum of 90 consecutive days:

  • Exclusions are available for the below measures:
  • e-Prescribing
  • Send Summary of Care
  • Request/Accept Summary of Care
  • Health Information Exchange(under 2018 Promoting Interoperability Transition Objectives and Measures)

For performance score choose to submit up to 9 measures for a minimum of 90 days for additional credit.

For bonus credits, eligible clinicians can:

  • Report to at least one additional Public Health Agency or Clinical Data Registry that is not reported under a performance score
  • Report Promoting Interoperability Objectives and Measures in performance year 2018 using only 2015 Edition CEHRT
  • Use certified EHR technology to complete certain Improvement Activities in the Improvement Activities performance category

OR

Request to reweight the Promoting Interoperability performance category if eligible clinicians belong to one of the following provisions

  • Hospital-based MIPS eligible clinicians
  • Ambulatory surgical center-based MIPS eligible clinicians
  • MIPS eligible clinicians using decertified EHR technology
  • Significant hardship exceptions under the MIPS

IA Reporting Requirements

The CMS has made only a few change to the MIPS IA Reporting Requirements for 2018. The key requirements for MIPS IA reporting requirements are as listed below:

The Improvement Activities (IA) performance category focuses on one of the MIPS strategic goals, to use a patient-centered approach to program development that leads to better, smarter, and healthier care.

For the performance year 2018, New Improvement Activities are finalized and previously adopted improvement activities have been updated along with the removal of a few existing activities.

MIPS would reward Improvement Activities falling into Care coordination, Beneficiary engagement, and Patient safety sub-categories which MIPS eligible clinicians could select from a list of approximately 112 activities.

Beginning with 2018 MIPS performance period, participants no longer require self-identifications for non-patient facing MIPS eligible clinicians, small practices, practices located in rural areas or geographic HPSA.

MIPS eligible clinicians or groups can simply attest to activities performed for a continuous 90 day period and qualify for reward in IA category.

Cost Reporting Requirements

The CMS has added included Cost category in the MIPS final score. Cost Performance Category has a weight of 10% in the MIPS Final Score for 2018 performance period. No reporting is required for this category as CMS will be calculating this on their end.

Cost Reporting Requirements
  • Cost performance category reporting period will be for the full performance year in 2018.
  • Individual eligible clinicians or groups will be scored on two measures included in the Cost performance category for 2018 MIPS Performance period-
  • Medicare Spending per Beneficiary (MSPB) and Total per Capita Cost measure for all attributed beneficiaries.
  • CMS will calculate Cost category score based on MIPS eligible clinicians’ performance compared to the measure benchmark.
  • Individual MIPS eligible clinicians and groups don’t have to submit any other information for the Cost performance category.