What are benchmarks and how do they apply to Quality scoring?

For quality measures, CMS uses data that was reported in previous years to create performance benchmarks.

Each quality measure is converted into a 10 point scoring system.  Performance on quality measures is broken down into 10 "deciles", with each decile having a value of between 3 and 10 points. A clinician or group's performance on a quality measure will be compared to the performance levels in the national deciles.  Registry measures are compared to registry benchmarks.

A measure can be reliably scored against a benchmark if...

A national benchmark exists

The sufficient case volume has been met (20 or more cases in the report)

At least 70% of possible data for a measure is submitted (data completeness)

Quality measures that can’t be reliably scored against a benchmark, or quality measures without a benchmark, will receive 3 points (assuming the measure meets data completeness) unless a benchmark can be established with performance period data.

New:  Beginning with the 2022 performance period, a new measure in its first year of the program will receive 7 points if it doesn’t meet case minimum or we can’t create a performance period benchmark, provided the measure meets data completeness criteria. A new measure in its second year of the program will earn 5 points if it doesn’t meet case minimum or we can’t create a performance period benchmark, provided the measure meets data completeness criteria.) If the quality measure does not meet data completeness it will receive 0 points (except for small practices which would receive 3 measure achievement points). If there is no comparable data from the baseline period, CMS will use information from the performance period to create measure benchmarks, which would not be published until after the performance period. This means that quality measures without a historical benchmark can earn between 3 and 10 points if a performance period benchmark is created.