Quality Scoring Logic
For 2023, CMS has updated the Quality category scoring logic. Some of the key changes to MIPS quality category scoring logic are:
30% of final score
Choose 6 quality measures to report on out of over 200. This must include at least 1 Outcome measure or 1 High Priority Measure (if an outcome measure is not available).
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 providers, are automatically subject to the All-Cause Hospital Readmission measure if they meet the case minimum of 200 patients for the measure.
Bonus Points: Clinicians receive bonus points for each of the following:
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 2023 Performance Year (PY), providers/practices can earn up to 10 percentage points based on the rate of their improvement in the Quality performance category from the previous year.
Topped Out measures
For 2023 PY, a special scoring cap of 7 points is applied to the measures that are identified as Topped Out.
Maximum score cannot exceed 100%
* Maximum number of points = Number of required measures x 10
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**
*Maximum number of points = Number of required measures x 10