Calculating the MIPS Composite Score

MIPS Calculation

June 18, 2018

Now that The Center for Medicare and Medicaid Services (CMS) has released preliminary data, eligible clinicians, that submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, are seeking clarity on how to determine their composite performance score. Note 2017 final scores will become available in July 2018.

Regardless of how you submitted the 2017 MIPS data, your 2017 MIPS composite score will determine penalty or bonus, progress or need for a new strategy. Let’s dig into the scoring mechanism in order to determine your score. Armed with this data you can determine the best path forward.

MIPS is a Medicare value-based payment system.  All MIPS eligible clinicians or eligible groups are evaluated across four performance categories–Quality, Cost, Advancing Care Information, and Improvement Activities–in order to determine payment adjustments that will be applied in future years.

The MIPS scoring system results in calculating a Composite Performance Score in the four categories on a scale of 0-100 points. Each performance category is assigned a weighted value, which can change each performance year.

The MIPS scoring methodology is also intended to take into account situations of exceptional performance, evaluation at the group or individual provider performance level, and the special circumstances of small practices, practices located in rural areas, and non-patient- facing MIPS eligible clinicians.

The quality performance category requires at least 6 quality measures (if available), 12-month reporting period, 60% of all payer data, and provides an opportunity to earn 10 bonus points for improving year-over-year. The quality performance category is worth 60 -70 points, plus the 10-point bonus. The quality performance category score contributes 60-85% of the total composite score depending on your patient facing status. You can participate in MIPS 2018 as a partial participant to avoid a penalty, which requires less data. Partial participation is expected to be elminated in 2019.

Quality performance benchmarks create a bridge connecting past performance to current state objectives. The better your peers perform, the further behind you risk falling.  Be aware, we are already seeing the impact of refined benchmarks. Earlier this year, our analytic engine identified quality measure gaps for a specific client.  Gaps impacting 3 patient encounters ( out of nearly 40,000 encounters) reduced the MIPS composite score by more than 20 points. It is vital to identify and close gaps prior to data submission.

Cost performance category evaluates eligible clinicians and groups on all applicable measures through their Medicare part B claims. The cost category is not weighted in 2017, as such, it will not contribute to the composite performance score. Hold on, don’t push it from your mind too fast. CMS has shared 2017 data for informational purposes. Reviewing your QRUR for performance outcomes will allow you to develop strategies to safe-guard against a penalty in 2018. Need help reading the report? Feel free to reach out, we can translate the ratios into improvement actions.

Advancing Care Information, now called Promoting Interoperability (PI) Programs, is composed of 2 performance levels. A base level worth 50 points requires performance in each of 5 base measures. An additional 90 points, 10 points per available measure can be earned by collecting and sharing health data through your electronic health record and/or participating in applicable data submission with a health registry.

Improvement Activities are designed to improve operational efficiency. The IA performance category is weighted at 15% of the composite score with a maximum of 40 points available. Note there are special criteria that reweight measures for participants in medical homes, rural and small practices. The transition from fee-4-service to value-based healthcare impacts clinical documentation, provider communication, analytics, and the use of technology. These adjustments are best implemented over a period of time. We recommend focusing on 1 or 2 improvements, while gaining credit for current processes that align with the value-based healthcare framework.

Are you ready to do the math? Plug in your performance category scores from 2017, complete the calculation to produce your 2017 Composite Performance Score.

Now that you have a composite score, let’s give it context. To avoid a penalty in 2017, you must have earned at least 3.0 points on the composite score. To become eligible for a bonus, scores over 3.0 and below 70.0 points are eligible for up to 4% bonus. Remember QPP is a budget neutral program and the bonus distribution will be limited to the total penalty imposed. Composite scores over 70 points results in up to 4% bonus plus a share in the incentive payment pool ($500 million dollars). 

Leverage your 2017 MIPS experience to develop a 2018 strategy that builds on your success and refines any opportunities. At Whittle Advisors, we guide clients to top-tier performance and leverage our registry to identify & remediate gaps improving our clients performance under MACRA/MIPS. We have protected over $4b in patient revenue from regulatory penalty. Contact us today to maximize your MIPS score.

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