Quality Improvement Scoring: 10 Things You Need to Know

The MIPS program in aims at encouraging continuous improvement in the healthcare delivered. To that end, Improvement scoring for the Quality performance category was introduced in the second year of MIPS (2018). As the name suggests, the improvement score will be calculated by direct comparison of performance data for Quality to the previous year’s performance. In other words, if an eligible clinicians scores better in 2019 than they did in 2018, they will be rewarded for it.

Here are 10 things that you need to know about how Improvement Scoring works for 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 Score Applied at the Quality 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. Remember that the selection of measures and the combination of the collection types used can significantly impact the final score. By using the overall category score, CMS is allowing flexibility to providers to select different measures in 2019 than 2018 if they need to.  

2. Quality Category Achievement Score Used As Base

The improvement determination will be based on the “Quality Performance Category Achievement Score”. This score has been defined as the Quality category score in the previous year WITHOUT the 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 Compared for the Same NPI

The score for 2019 would be compared to the 2018 score submitted by the same NPI even if it was under a different TIN or a different Submitter Type (Individual, Group, Virtual Group or APM entity). CMS has also provided guidelines if the submission identifier for an individual or a group changes in 2019 (e.g. provider leaves a group or decided to submit as an individual).

4. 30% of Max Quality Score Serves as the Base for Improvement Score

If the reported quality score in 2018 was less than 30% of the maximum possible quality score CMS will compare to an assumed 2018 performance score of 30%. For most providers, the maximum quality points in 2018 are 60. If a provider has less than 18 points (30%) in 2018, their 2019 score would be compared to an assumed 18 points in 2018. If you are eligible for re-admission measure in 2018, the comparison score for 2018 would be 21 (30% of 70).  

6. Full Participation in 2019

A full participation is required in 2019 to be eligible for the improvement score bonus. This includes submission of all required measures and meeting data completeness criteria. 

7. Improvement Score Calculation

The improvement score will be calculated as a percent and then added to the Quality percent score before multiplying it with the Quality category weight to determine the Quality category score.

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 Percentage Points

The maximum scoring improvement bonus points allowed are 10 percentage points. 

9. No Penalty

There is no penalty if your Quality category performance in 2019 decreases as compared to 2018. 

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:

Quality Performance Category Percent Score = [(Total Measure Achievement Points + Total Bonus Points) / Total Applicable Measure Achievement Points] x 100 + Improvement Percent

The total percent score after adding improvement percent score cannot exceed 100 percent . This score combined with the quality category weight would determine the final Quality Category Score in the Composite Performance Score.

Quality Performance Category Percent Score x 45 = Quality Category Score (for 2019)

If your organization did not ace the Quality category in 2018, there is room for improvement in 2019 and gain a little extra benefit from your efforts. Although CMS will automatically calculate this for all the eligible clinicians, it helps to be vigilant when 2018 Targeted Review Reports become available and ask for any necessary clarification.

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