• MIPS 2019—Fundamentals: Four Performance Categories

    This content was excerpted from EyeNet’s MIPS 2019; also see the Academy’s MIPS hub page


    Your 2019 MIPS final score (0-100 points) will be based on your scores in up to four performance categories. For each performance category, you’ll get a score of 0%-100%, and its contribution to your MIPS final score will depend on how it is weighted. The default weighting that CMS uses for these performance categories is as follows:

    1) Quality performance category is weighted at 45% (down from 50% in 2018), meaning your quality score contributes up to 45 points to your MIPS final score. For example, if your quality score is 60%, it would contribute 27 points (60% of 45 = 27). This performance category evolved out of the Physician Quality Reporting System (PQRS).

    2) Promoting interoperability (PI) performance category is weighted at 25%, meaning it contributes up to 25 points to your MIPS final score. However, if one of the PI exceptions apply, this contribution will be reduced to 0%, with quality’s contribution being reweighted upward (see Table 2B, below). This performance category had evolved out of the meaningful use (MU) program for electronic health records (EHRs) and, until April 2018, it was known as advancing care information (ACI). CMS said that it changed the name from ACI because it is “promoting and prioritizing the interoperability of healthcare data.”

    3) Improvement activities performance category is weighted at 15%, meaning it contributes up to 15 points to your MIPS final score. In 2019, this performance category is largely the same as it was in 2018, though there are 10 additional improvement activities available for reporting manually via the IRIS Registry (see Table 13: Improvement Activities—at a Glance). You may also see this category referred to as clinical practice improvement activities (CPIAs), the  term used in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which is the statute that underpins the QPP.

    4) Cost score is weighted at 15% (up from 10% in 2018), meaning it contributes up to 15 points to your MIPS final score. You don’t report any additional data for cost; CMS will determine your cost score based on Medicare administrative claims data. You will sometimes see this category referred to as resource use, which is the term used in the 2015 statute. New this year, CMS has developed an episode-based cost measure for routine cataract surgery.

    In some situations, CMS may reweight how performance categories contribute to your MIPS final score. In addition to the PI exceptions mentioned above, there are very limited circumstances in which you could apply to have one or more of these four performance categories reweighted (see Quakes, Fires, and Other Disasters!). Reweighting also occurs if you don’t meet the case minimum for any cost performance category measures.

    Table 2A: 2019 MIPS Final Score (Default Composition)

    Performance Category Weight Points
    Quality 45% 0-45 points
    + Promoting interoperability 25% 0-25 points
    + Improvement activities 15% 0-15 points
    + Cost 15% 0-15 points
    = MIPS final score   0-100 points

    Table 2B: 2019 MIPS Final Score (Composition if a PI Exception Applies)

    Performance Category Weight Points
    Quality 70% 0-70 points
    + Promoting interoperability    
    + Improvement activities 15% 0-15 points
    + Cost 15% 0-15 points
    = MIPS final score   0-100 points

    Table 2C: 2019 MIPS Final Score (Composition if You Don’t Meet the Case Minimum for Any Cost Measures)

    Performance Category Weight Points
    Quality 60% 0-60 points
    + Promoting interoperability 25% 0-25 points
    + Improvement activities 15% 0-15 points
    + Cost    
    = MIPS final score   0-100 points

    Table 2D: 2019 MIPS Final Score (Composition if a PI Exception Applies and You Don’t Meet the Case Minimum for Any Cost Measures)

    Performance Category Weight Points
    Quality 85% 0-85 points
    + Promoting interoperability    
    + Improvement activities 15% 0-15 points
    + Cost    
    = MIPS final score   0-100 points

    Previous: Fundamentals: Timeline for Performance Year 2019

    Next: Fundamentals: Which Reporting Mechanism?

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