This content is excerpted from EyeNet’s MIPS 2022: A Primer and Reference; also see the Academy’s MIPS hub page.
Your 2022 MIPS final score (0-100 points) is a composite score. As in past years, your MIPS final score will be based on your weighted scores in up to four performance categories. Their default weights are as follows:
What the weights mean. If your quality score is weighted at 30%, it can contribute a maximum of 30 points to your MIPS final score; for example, a quality score of 60% would contribute 18 points (60% of 30 points). In some circumstances, CMS can reweight the performance categories’ contributions to your MIPS final score.
Get up to 10 bonus points for patient complexity. If you report MIPS data for at least one performance category, you may be eligible for a complex patient bonus. CMS determines the complex patient bonus based on two indicators:
- the average Hierarchical Condition Category (HCC) risk score of your patients; and
- a “dual eligible” score, which is based on the proportion of beneficiaries eligible for both Medicare and Medicaid.
The complex patient bonus is now more targeted. Even if your patient mix remains the same, your complex patient bonus for 2022 may differ from the one that you received in 2021. Starting in 2022, you will be eligible for the complex patient bonus only if you have at least a median a score for the HCC indicator and/or the dual eligible indicator. CMS also has revised the formula for calculating the number of bonus points that you will receive, with the goal of better rewarding those who are delivering care to highly complex patients.
Calculating your MIPS final score. Your MIPS final score is the sum of your weighted performance category scores (0-100 points) plus your complex patient bonus (0-10 points). It is capped at 100 points,
Example. In a hypothetical example, a clinician scores 60% for quality, 80% for promoting interoperability, 100% for improvement activities, and 60% for cost. If the default weights of those four performance category scores apply, then they would contribute to her MIPS final score as follows:
- quality score of 60% contributes 18 points (60% of 30 points)
- promoting interoperability score of 80% contributes 20 points (80% of 25 points)
- improvement activities score of 100% contributes 15 points (100% of 15 points)
- cost score of 60% contributes 18 points (60% of 30 points)
If the clinician’s complex patient bonus contributes 2 bonus points, then the MIPS final score would be 73 points (the sum of 18 + 20 + 15 + 18 + 2).
Next: Reweighting the Performance Categories
DISCLAIMER AND LIMITATION OF LIABILITY: Meeting regulatory requirements is a complicated process involving continually changing rules and the application of judgment to factual situations. The Academy does not guarantee or warrant that regulators and public or private payers will agree with the Academy’s information or recommendations. The Academy shall not be liable to you or any other party to any extent whatsoever for errors in, or omissions from, any such information provided by the Academy, its employees, agents, or representatives.
COPYRIGHT© 2022, American Academy of Ophthalmology, Inc.® All rights reserved. No part of this publication may be reproduced without written permission from the publisher. American Academy of Ophthalmic Executives® and IRIS® Registry, among other marks, are trademarks of the American Academy of Ophthalmology®.
All of the American Academy of Ophthalmology (AAO)–developed quality measures are copyrighted by the AAO’s H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care (see terms of use).