Merit-Based Incentive Program System




As many of you know the Merit-Based Incentive Program System (MIPS) composite score consists of 4 different categories. The Quality category is the beast weighing in at 60% of the score and is probably the most confusing. To get a perfect Quality score an eligible clinician needs to earn 60 to 70 points from reporting their quality measures and collecting bonus points.

Each measure is assigned to one or more submission methods. Before you start scanning and investigating quality measures, first determine what data submission methods your current systems and vendors can support. The submission methods available are EHR, qualified registries, claims, CMS web interface and CSV files. Next, you should identify 6 out of the remaining 271 measures across any combination of domains where 1 must be either an outcomes measure or a high-priority measure when an outcomes measure is not available.

First, make sure you will have at least 20 patient cases that meet the measurement criteria. If you have less than 20 cases to report, CMS will assign a minimum score of 3 points (2017 only) for the quality measurement. You’ll also be required to report on 50% of patients who meet the measurement denominator criteria. If you have more than 20 cases you can be selective on what cases you would like to report. Second, you may want to hold off on selecting a new measure. If CMS receives data from < 20 clinicians, you’ll be limited to receiving 3 points, but if >= 20 clinicians report the quality measure you could get more points; it will be difficult to predict your score since CMS will be creating the benchmark for the first time with 2017 data reported. Furthermore, if you select the most simple and common Quality measure, you may find yourself competing with most of the other participating clinicians, which may reduce your incentive payments and won’t provide exciting metrics when marketing your practice or negotiating higher reimbursement rates. Lastly, be careful when using to filter quality measures for your practice. There are 190 quality measures not tied to a specialty that may get largely overlooked but could be great measures for your practice.

Let’s assume you have boldly selected an outcome and high priority quality measure like “Optimal Asthma Control” (PQRS #398). You have verified that your tool can submit data, and you will easily have 20 or more cases so you won’t get dinged with a minimum 3-point score. Slow down a minute because CMS has decided to slightly complicate quality scoring and earning points. Each measure will have up to 10 decile points. Decile points? And every year, CMS will graciously publish decile tables for each measure based on national performance in a baseline period (which is 2 years prior to your performance period). The points you are awarded for each measure depends on how your score fits within 10 decile ranges. So, if your “Optimal Asthma Control” calculation is 82% you could get anywhere from 6 to 10 points based on national performance.

Let Us Help You

Oasis Practice Solutions, Inc. can analyze your practice’s claim data to help determine which measures are appropriate for practices. If needed, we can provide a fully integrated solution to simplify the collection and reporting requirements necessary to fully participate in the QPP, which will improve the health of your patients and increase the value of your practice.