Quality Payment Program and Quality Measure Benchmarks

The key to successful Merit-based Incentive Payment System (MIPS) reporting is your engagement in the process. As discussed in previous columns, there are 4 categories of MIPS-eligible clinician performance contributing to a composite performance score of up to 100 points: Quality (weighted at 60% for 2017), Advancing Care Information (weighted at 25% for 2017), Improvement Activities (weighted at 15% for 2017), and Cost (weighted at 0% for 2017, but will be weighted for 2018 and in future).

In this column, we are digging deeper into the “Quality” category and taking a closer look at the Quality Measure Benchmarks. The following information is directly referenced from the Quality Measure Benchmarks Overview.¹ Under the “documents and downloads” section, you can download the 2017 Quality Measure zip file at https://qpp.cms.gov/about/resource-library to access the Quality Measure Benchmarks Overview document for your files. It is the fourth URL in the list.

When a clinician submits measures for the MIPS Quality Performance Category, each measure is assessed against its benchmarks to determine how many points the measure earns. A clinician can receive anywhere from 3 to 10 points for each measure (not including any bonus points). Benchmarks are specific to the type of submission mechanism: electronic health records (EHRs), Qualified Clinical Data Registry (QCDR)/registries, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and claims. These historic benchmarks are based on actual performance data submitted to PQRS in 2015, except for CAHPS. For CAHPS, the benchmarks are based on 2 sets of surveys: 2015 CAHPS for Physician Quality Reporting System (PQRS) and CAHPS for Accountable Care Organizations. Submissions via the Centers for Medicare & Medicaid Services Web Interface will use benchmarks from the Shared Savings Program.

Each benchmark is presented in terms of deciles. Points will be awarded within each decile (see Table, http://links.lww.com/NSW/A2). Clinicians who receive a score in the first or second decile will receive 3 points. Clinicians who are in the third decile will receive somewhere between 3 and 3.9 points, depending on their exact position in the decile; clinicians in higher deciles will receive a corresponding number of points. For example, if a clinician submits data showing 83% on the measure, and the fifth decile begins at 72% and the sixth decile begins at 85%, then the clinician will receive between 5 and 5.9 points because 83% is in the fifth decile. For inverse measures where a positive performance is seen in a lower score, the scores are reversed in the benchmark deciles, and higher scores are in lower deciles, but the lowest deciles still receive the lowest points.

Cathy is Chief Clinical Officer for WoundExpert® and Vice President at Net Health, and in addition to being the MIPS Clinical Consultant for WoundExpert. She gained over 30 years of expertise in various acute care, long-term care, sub-acute care facilities, home-health agencies, and outpatient wound care department settings. Cathy is the author of Clinical Guide to Skin and Wound Care (also translated into Italian and Portuguese) – Eighth Edition published in September of 2018.