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MIPS Quality Performance Scoring & Reporting for Medicare Incentives

2017 is quickly turning into a year of unforeseen challenges and opportunities. MIPS that consolidates four major reforms under one umbrella is sending ripples across the healthcare circles.

At a recent conference organized by HIMSS, Dr.Reena Duseja, director of the division of quality measurement, CMS shed some light on MIPS quality performance categories and scores.

This infographic illustrates the MIPS quality performance scores, benchmarks and reporting mechanisms.

Merit Based incentive payment System for Medicare Reimbursement Payments

It is time for healthcare professionals to prepare their organizations for MIPS and fleshing out a plan to achieve optimal quality scores and Medicare reimbursement. Hope this infographic will be a small step towards that direction.

Kindly share this MIPS infographics, if you found it useful. Many thanks in advance.

Transcript of the infographics

At HIMSS17, a CMS director elaborated on the MIPS quality and cost performance categories in 2017 and advised clinicians on how to report for maximum reimbursements. first Quality Payment Program performance year two value-based reimbursement tracks



CMS anticipates 592,000 to 642,000 eligible clinicians to participate in MIPS during the 2017 transition year. eligible clinicians must submit some data to avoid a negative Medicare payment adjustment in 2019.

To prevent a financial penalty, eligible clinicians must submit data on all the required advancing care information measures.Submitted data must cover at least a 90-day period, but could include a full year period.

The MIPS cost category will also not be counted for Medicare payment adjustments in 2017 but eligible clinicians will be assessed on their cost management performance starting in 2018.

Maximize Medicare reimbursement under the program in 2017. In 2017, eligible clinicians have the option of submitting one to six MIPS quality performance measures.

MIPS clinicians have 271 quality measures to choose from in 2017 Clinicians can also potentially earn higher positive Medicare payment adjustments in 2019 by submitting data on more measures.

Clinicians will follow a partial MIPS participation plan and qualify for a higher adjustment by providing data on at least three quality measures, Even greater Medicare payment adjustments will be available to clinicians who fully participate by submitting data on at least six quality measures.

Submit data on the six measures with one being an outcome or high-priority measure. CMS defines a high-priority measure as an outcome, appropriate use, patient experience, patient safety, efficiency, or care coordination measure.

MIPS quality measures are similar to the Physician Quality Reporting System (PQRS), but MIPS reduced the reporting burden on clinicians.

Clinicians fully participating in 2017 Quality component of MIPS will represent 60 percent of the total MIPS performance score.

Each quality measure is worth up to 10 points based on performance benchmarks. Submitting sufficient data will automatically earn a clinician 3 points in 2017.

Clinicians can earn more than 3 points if, the measure can be “reliably scored against a benchmark. a reliable score means that there is sufficient case volume (20 or more cases for most measures), data is complete (at least 50 percent of possible data submitted), and a benchmark exists for the measure. each measure’s benchmark based on the reporting mechanism.

Therefore, the following will have separate benchmarks: • EHRs • Qualified Clinical Data Registry and other registries

• CMS Web Interface

• Administrative claims measures

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for MIPS

If a benchmark is not available for a certain measure, then clinicians will automatically receive 3 points for submitting data on that measure.

Earn bonus quality performance points in 2017 For one extra point, clinicians can submit an additional high-priority measure and two bonus points will be awarded for submitting data on additional outcome and patient experience measures.

Two bonus points will also go to clinicians who use certified EHR technology to submit data. Another bonus point is also available if data is submitted “electronically end-to-end.”

The maximum points available in the quality category is 60 points.

For a group of 16 or more clinicians with less than 200 cases qualifies for the readmission measure, in which case the maximum points will be 70 points.

CMS developed different maximum points and measure requirements for groups reporting through the CMS Web Interface.

The score will be determined using the following equation by federal agencies.

Total Quality Performance Category Score = [Points earned on required six quality measures + any bonus points]/Maximum number of points


cost performance category will not be weighed in 2017 final performance scores.

It’s a relatively new concept for providers. we’re developing the measures. The federal agency will use Medicare claims data to assess eligible clinicians on measures already used in the Physician Value-Based Modifier program and those used in the Quality and Resource Use Report.

The cost measures are Medicare spending per beneficiary, total spending per capita, and ten episode groups. At the most basic level, the cost evaluations will be based on “Medicare payments for items and services furnished to a beneficiary during an episode of care.

More specifically, CMS will develop cost measures using the following five components: • Define an episode group • Determine costs for an episode group

• Attribute the episode group to one or more responsible clinicians

• Risk adjust an episode group to compare like beneficiaries, such as case mix

• Align an episode group’s costs with quality indicators

MIPS cost measures will also be divided into three episode groups. chronic condition acute inpatient medical condition procedural episode groups. MIPS Cost Measures Goal How do we improve patient outcomes and how do we spend smarter in terms of how we are taking care of our patients.

All stakeholders can comment federal agency approach to cost measure development until April 24, 2017 on CMS website eligible clinicians may consider using the transition year to learn more about the MIPS category before it launches in the 2018 performance year.

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