2019 MIPS Quality Benchmarks

What Are Quality Measure Benchmarks?

When a clinician or group submits measures for the Merit-based Incentive Payment System (MIPS) quality performance category, each measure is assessed against its benchmark to determine how many points the measure earns. In program year 2018, a clinician or group can receive anywhere from 3 to 10 points for each MIPS measure (not including any bonus points) that meets the data completeness standards and case minimum requirements through Benchmarks. Benchmarks are specific to the collection type: Qualified Clinical Data Registry (QCDR) measures, MIPS Clinical Quality Measures (MIPS CQMs), eCQMs, CMS Web Interface measures, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey, and Part B Claims measures. In order to measure performance that is comparable across the spectrum of performance, benchmarks are established using historical data. Historical benchmarks are based on actual performance data from 2017 that was submitted to the Quality Payment Program (QPP) in 2017, except for the CAHPS surveys. For 2019 CAHPS for MIPS, we have not yet established benchmarks. The CMS Web Interface uses benchmarks from the Medicare Shared Savings Program.

How Are Benchmarks Displayed?

Each benchmark is presented in terms of deciles. Points will be awarded within each decile (see table below). Clinicians who receive a score in the first or second decile will receive 3 points. Clinicians who are in the 3rd decile will receive somewhere between 3 and 3.9 points depending on their exact position in the decile, and clinicians in higher deciles will receive a corresponding number of points. For example, if a clinician submits performance data of 83% on a non-inverse measure, and the 5th decile begins at 72% and the 6th decile begins at 85%, then the clinician will receive between 5 and 5.9 points because 83% is in the 5th decile. For inverse measures where a higher performance is seen by a lower number on the performance score, the scores are reversed in the benchmark deciles. One can find more info on this CMS 2019 Quality Measure Benchmark Fact Sheet. An Excel version of the 2019 MIPS Quality Historic Benchmarks can be found here. 

We marked at blue measures that can earn a maximum score of 7 points. These measures were topped out in 2018 and also in 2019 (ie, second year in a row) and are subject to scoring cap of 7 points. Topped-out means that the national median performance rate is so high that there is no meaningfull difference in performance between clinicians.