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  • Table 6: Some Quality Measures Are Subject to Scoring Limitations

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

    When selecting quality measures, you should note that some measures are subject to a 7-point cap on achievement points (see Table 6A), scoring for some measures “stalls” before the 10th decile (see Table 6B and Table 6C), and some measures don’t yet have a benchmark. (When a measure doesn’t yet have a benchmark for a particular reporting mechanism, CMS will try to create a benchmark based on 2019 performance data; but if there are not enough data to create a reliable benchmark, you won’t be able to earn more than 3 achievement points for the measure when using that reporting mechanism.)

    Table 6: Examples of Scoring Limitations

    For some benchmarks, the full range of achievement points (3-10 achievement points) is not available. (Note: Measures can have different benchmarks for different collection types. Measure 130, for example, has one benchmark for reporting via EHRIRIS Registry integration, a second benchmark for manual reporting via the IRIS Registry, and a third benchmark for claims-based reporting.)

    Table 6A: Achievement Point Score Can Be Subject to a 7-Point Cap

    Example—Measure 130: Documentation of Current Medications in the Medical Record (benchmark for reporting via EHR–IRIS Registry integration). The 7-point cap on achievement points is applied to measures that are in their second year of being topped out. CMS considers a measure to be topped out when a lot of clinicians are attaining, or almost attaining, maximum performance for that measure (e.g., the average performance rate is 95% or higher). Note: This 7-point cap doesn't apply to bonus points.

    Achievement points: 3-7 points.  
    Notes: Topped out, 7-point cap.  
    Decile Performance  Rate Achievement
    d3 87.55%-93.48% 3.0-3.9 points
    d4 93.49%-96.28% 4.0-4.9 points
    d5 96.29%-97.98% 5.0-5.9 points
    d6 97.99%-98.99% 6.0-6.9 points
    d7 99.00%-99.57% 7.0 points
    d8 99.58%-99.88% 7.0 points
    d9 99.89%-99.99% 7.0 points
    d10 100% 7.0 points

    Table 6B: Achievement Point Score Can Stall Before the 10th Decile

    Example—Measure 402: Tobacco Use and Help With Quitting Among Adolescents (benchmark for reporting manually via the IRIS Registry). In this example, scoring stalls at 8.9 points because this benchmark reaches a 99.99% performance rate at the eighth decile.
    Achievement points: 3-8.9 points or, with a 100% performance rate, 10 points.
    Notes: Topped out
    Decile Performance Rate Achievement Points
    d3 86.36%-91.17% 3.0-3.9 points
    d4 91.18%-94.11% 4.0-4.9 points
    d5 94.12%-96.11% 5.0-5.9 points
    d6 96.12%-97.58% 6.0-6.9 points
    d7 97.59%-98.83% 7.0-7.9 points
    d8 98.84%-99.99% 8.0-8.9 points
    d10 100% 10 points  

    Table 6C: Achievement Point Score May Stall Before the Third Decile

    Example—Measure 12: POAG: Optic Nerve Evaluation (benchmark for reporting via Medicare Part B claims). Some benchmarks reach a 99.99% performance rate before the third decile. However, you can earn 3 achievement points for a measure, even if your performance rate falls below the third decile. This is because CMS only compares your performance rate against a benchmark if you satisfy both the case minimum requirement (at least 20 patients) and the data completeness criteria (at least 60% of denominator-eligible patients). If you satisfy both those data submission thresholds, you earn a minimum of 3 achievement points. (If you meet the 60%-data completeness criteria but not the 20-patient case minimum, your performance rate won't be compared against the benchmark, but you will still earn either 3 or 1 achievement pionts, depending on whether you are in a small or large practice, respectively.)

    Achievement points: 3 points or, with a 100% performance rate, 7 points.
    Notes: Topped out, 7-point cap.
    Decile  Performance Rate Achievement Points
    d1 & d2  ≤ 99.99% 3.0 points
    d10 100% 7.0 points  

    Previous: Getting a High Score for Quality Gets More Challenging Each Year 

    Next: Table 7: Reporting Quality Measures via IRIS Registry–EHR Integration or Table 8: Manually Reporting Quality Measures via the IRIS Registry or Table 9: Reporting Quality Measures via IRIS Medicare Part B Claims

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