Business of Medicine
MIPS Performance Categories
By Bill Kanich, MD, JD
October 26, 2017
Participants in the Merit-Based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) will report measures in three categories in 2017:
- Advancing Care Information and;
- Improvement Activities
A fourth category, Cost, will be calculated for the practitioner based on submitted claims.
MIPS Performance Category: Quality
The Quality category will be the most heavily weighted category this year, it will account for 60% of the final score in 2017. The Quality category replaces the Physician Quality Reporting System (PQRS) and Quality portion of the Value Modifier.
Within the Quality category, there are more than 270 measures from which to choose. If a practitioner chooses to submit the minimum data for 2017, he must only submit one Quality Measure. For partial or full-year participation, a practitioner must submit at least six individual measures. One of these measures must be an outcome measure. If an outcome measure is not applicable to your specialty, another high-priority measure may be submitted.
When considering which Quality Measures to submit, consider the following:
- Your patient population
- The conditions you most frequently treat
- Your practice location
- Quality data that you may submit to other payers
- Your specialty – there are specialty-specific measures
Individual clinicians can report Quality Measures through a Qualified Clinical Data Registry (QCDR), a qualified registry, EHR, or through submitted claims. Groups that are submitting data can use these methods as well as the CMS Web Interface and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Clinicians can only use one reporting method per performance category. An exception to this is CAHPS. If a clinician uses CAHPS it counts as a Quality Measure, so it is permissible to use one other reporting mechanism to report the remaining measures.
Clinicians may submit more than the minimum number of Quality Measures. If a clinician reports more than six Quality Measures, CMS will use the six measures with the highest scores to calculate the Quality Score.
It is important to keep in mind that the ultimate score that a practitioner receives will be based more on the quality of the measures submitted rather than the quantity of measures submitted.
In addition to the self-reported measures CMS will calculate the all-cause hospital readmission measure for groups of 16 or more clinicians with at least 200 cases.
The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.