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MIPS Performance Categories

MIPS Performance Categories

Each clinician or group will have a MIPS composite performance score (CPS) which will factor in performance in 4 weighted performance categories on a 0-100 point scale.  The four performance categories include:

Quality
QUALITY

50% of total score

This category replaced the PQRS program.

  • Individual clinicians or groups will choose six individual measures to report.  
  • The measures must include at least one outcome measure (if available) or another high priority measure.  High priority quality measures are those related to patient outcomes, appropriate use, patient safety, efficiency, patient experience, or care coordination.  A cross cutting measure is not required in 2018.
  • The minimum reporting rate is 60% of eligible cases per measure in 2018.  
  • Individual quality measures can be reported/chosen from a comprehensive list or from a specialty-specific measure set (if one exists for your specialty).  
  • View here the list of Quality Measures

Advancing Care Information
ADVANCING CARE
INFORMATION

25% of total score

This category replaced the EHR Meaningful Use.

  • Clinicians will be required to use certified EHR technology (2014 OR 2015 Certified) and will choose to report customizable measures that reflect how they use technology in their day-to-day practice. 
  • There is a minimum of a 90 day reporting period in 2018.
  • Bonuses available for registry reporting.
  • Visit the list of Advancing Care Information measures

Improvement Activities
IMPROVEMENT
ACTIVITIES

15% of total score

This measure rewards clinical practice improvements, such as activities focused on care coordination, beneficiary engagement, and patient safety (e.g.,expanded practice access, such as same-day appointments for urgent needs).  

  • Clinicians can select activities that match their practices’ goals from a list of more than 100 options.
  • Performance in this category is calculated based on the provider's attestation to completing 2 high-weighted activities or 4 medium-weighted activities for a minimum of 90 days.
  • For small practices (fewer than 15 providers billing with the same TIN), rural practices, or practices located in geographic health professional shortage areas (HPSAs), providers are only required to report 1 high-weighted or 2 medium-weighted activities for full participation.
  • View the list of Improvement Activities

Cost
COST

10% of total score

This category has no reporting requirements for clinicians.  

This will be calculated by CMS based on claims submitted.

 

MIPS Payment Adjustments

The four performance category scores (Quality, Advancing Care Information, Improvement Activities and Cost) would be aggregated into a MIPS composite performance score (CPS).  The MIPS CPS will be used to calculate a positive, negative or neutral adjustment to clinicians’ Medicare Part B payments.  Payment adjustments would be based on the relationship between a clinician’s CPS and a MIPS performance threshold.  

  • MIPS clinicians can receive neutral, positive or negative payment adjustments in 2020.  Eligible clinicians with less than 15 MIPS points will receive up to a 5% penalty in 2020.
  • A score above 15 MIPS points will yield a positive payment adjustment based on the amount of penalties collected from clinicians with scores below 15 (MIPS is budget neutral program)
  • An additional bonus will be applied to payments to high performers with scores above 70 MIPS points.

 

Further information can be found at: