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

60% of total score (in year 1: 30% when fully transitioned)

This category replaces the current PQRS program.

  • Individual clinicians or groups will choose six measures to report (versus the nine measures currently required under PQRS).  Measures groups are no longer available for reporting purposes.
  • 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 2017.
  • The quality reporting threshold is 50% of eligible patients per measure in 2017 (will increase to 60% 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 the list of Quality Measures: https://qpp.cms.gov/measures/quality

Advancing Care Information
ADVANCING CARE
INFORMATION

25% of total score (in year 1)

This category replaces the EHR Meaningful Use.

  • Clinicians will be required to use certified EHR technology and will choose to report customizable measures that reflect how they use technology in their day-to-day practice. Unlike the existing reporting program, this category will not require all-or-nothing EHR measurement or duplicative quality reporting.
  • There are 90 day reporting periods in 2017 and 2018.
  • Bonuses available for registry reporting.
  • Clinicians will no longer be required to report on the Clinical Decision Support (CDS) and the Computerized Provider Order Entry (CPOE) measures.
  • Visit the list of Advancing Care Information measures: https://qpp.cms.gov/measures/aci

Improvement Activities
IMPROVEMENT
ACTIVITIES

15% of total score (in year 1)

This category is new.

It will reward 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 90 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 Activity measures: https://qpp.cms.gov/measures/ia
  • Click here to download the Improvement Activity Data Validation criteria from the CMS QPP website.

Cost
COST

0% of total score (in year 1; 30% when fully transitioned)

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 of +/- 4 percent in 2019.  Only eligible clinicians who choose not to report any data during the 2017 transition year would receive the 4% penalty in 2019.  This number will increase to 5 percent in 2020, 7 percent in 2021 and 9 percent in 2022. 
  • A CPS that falls at or above the threshold will yield payment adjustment of 0 to +12% (based on the degree to which the CPS exceeds the threshold and the overall CPS distribution).
  • An additional bonus (up to 10%) will be applied to payments to high performers.

 

Further information can be found at:

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