MIPS 2018 Quality Performance Improvement Scoring: 10 Things You Need to Know

In the last blog, we discussed the details on how the Cost Category Score would now be included in the calculation of the final MIPS score in 2018. Another significant addition to the scoring component in 2018 is the “Improvement Scoring” bonus points for the Quality and the Cost categories. As the name suggests, these are bonus points available in 2018 for demonstrating improvement as compared to 2017 for just these two categories. As 2017 is the first year for MIPS, 2018 will be the first year where these bonus points will be available.

Here are 10 things that you need to know about scoring improvement bonus points in the Quality category:

“Scoring Improvement” bonus points for the Quality and the Cost categories are bonus points available in 2018 for demonstrating improvement in 2018 as compared to 2017 scores. As 2017 is the first year for MIPS, 2018 will be the first year where these bonus points will be available.   Here are 10 things that you need to know about scoring improvement bonus point in the quality category.


1. Improvement Bonus Applied at the Category Level

The bonus for improvement will be applied at the overall category score level. There is no measure level component available for these bonus points. As we had discussed previously, the selection of measures and the submission method can significantly impact the final score. By using the overall category score, CMS is allowing flexibility to providers to select any measures and/or submission method in 2018 irrespective of what they select in 2017.


2. Quality Performance Category Achievement Score

The improvement determination will be based on the “Quality Performance Category Achievement Score”. This score has been defined as the Quality category score WITHOUT INCLUDING any bonus points. [Read more about the Quality bonus points] The improvement bonus points earned in 2018 also WON’T be included for calculating this Achievement Score in future years.


3. Quality Score for 2017 and 2018 Required

The score for 2018 would be compared to the 2017 score submitted under the same identifier defined as TIN/NPI for individual or TIN for group/APM entity as far as possible. CMS has also provided guidelines if the submission identifier for an individual or a group changes in 2018 (e.g. provider leaves a group or decided to submit as an individual). The virtual group identifiers will be used starting 2019 for virtual group participants.


4. Minimum Score of 3 Points Required

There must be a quality category performance achievement score (greater than or equal to 3) for 2017 and 2018 to be eligible to receive improvement scoring bonus points.


5. 30% of Max Quality Score Serves as the Base for Improvement Score

If the reported quality score in 2017 was less than 30% of the maximum possible quality score CMS will compare to an assumed 2017 performance score of 30%. For most providers, the maximum quality points in 2017 are 60 points. If a provider has less than 18 points (30%) in 2017, their 2018 score would be compared to an assumed 18 points in 2017. If you are eligible for re-admission measure in 2017, the comparison score for 2017 would be 21 (30% of 70). The 30% floor was added to ensure that a Test Pace participant does not receive undue benefit for a low score in 2017.


6. Full Participation in 2018

A full participation is required in 2018 to be eligible for the improvement score bonus. This includes submission of all required measures and meeting data completeness criteria.


7. Bonus Point Calculation Equation

The bonus points are calculated based on the following formula:

Improvement percent score = (increase in quality performance category achievement percent score from prior performance period to current performance period / prior performance period quality performance category achievement percent score) x 10 percent


8. Maximum 10 Points

The maximum scoring improvement bonus points allowed are 10 points.


9. No Penalty

There is no penalty if your Quality category performance in 2018 decreases as compared to 2017.


10. Calculation of Final Quality Performance Score

The improvement percent score bonus would be added to the quality performance category score after calculating the score based on measures scores and measure based bonus points. The final Quality performance category percent score would be calculated by the following formula:

[(Total Measure Achievement Points + Measure Bonus Points)/Total Available Measure Achievement Points] + Improvement Percent Score

The total percent score after adding improvement percent score cannot exceed 100 percent. Similar to 2017, this score combined with the quality weightage would determine the final Quality Category Score in the Composite Performance Score.

A 10% bonus can really go a long way to achieving a perfect MIPS score of 100 in 2018. The 2018 edition of MyMipsScore will automatically calculate your improvement score if you utilize MyMipsScore to submit your 2017 data.


Learn How You Can Use MyMipsScore to Maximize Your MIPS Score and Related Payment Adjustment


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