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  • MIPS 2023—Quality: How CMS Calculates Your Quality Score

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    This content is excerpted from EyeNet’s MIPS 2023: A Primer and Reference; also see the Academy’s MIPS hub page.

    This can be described as a four-step process.

    1. CMS calculates your achievement points total: CMS determines your total mea­sure achievement points, which is the sum of your achieve­ment points for up to six quality measures that you reported plus—if applicable—your score for the HWR measure (see “The HWR Measure for Large Practices”).

    2. CMS determines your numerator: CMS calculates your numerator, which is your total measure achievement points plus—if you are in a small practice that submits data on at least one quality measure—a 6-point small practice bonus.

    3. CMS determines your denominator: CMS calculates your denominator, also known as your total available measure achievement points, which—assuming that you had at least six quality measures available to report—is 60 (or 70 if the HWR measure applies). In limited circumstances, CMS may determine that you have fewer than six quality measures to report and can reduce that denominator accordingly. If, for example, you report a measure that has been suppressed, CMS would reduce your denominator by 10.

    4. CMS does the math: CMS divides your numerator by your denominator, turns the resulting fraction into a per­centage, and then your improvement percent score is added.

    The resulting percentage is your quality performance category per­cent score, which is capped at 100%. Unless your performance categories are reweighted (see “Reweighting the Performance Categories”), it contributes up to 30 points to your MIPS final score. For example, if your quality score is 60%, it would contribute 18 points (60% of 30 points).

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    All of the American Academy of Ophthalmology-developed quality measures are  copyrighted by the AAO’s H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care (see terms of use).