• MIPS 2018—Nuts and Bolts: 4 Performance Categories

    Written By: Rebecca Hancock, Flora Lum, MD, Chris McDonagh, Cherie McNett, Jessica Peterson, MD, MPH, and Sue Vicchrilli, COT, OCS

    This content was excerpted from EyeNet’s MIPS 2018; also see the Academy’s MIPS hub page


    Your 2018 MIPS final score (0-100 points) will be based on 4 performance scores. For each performance category, you’ll get a score of 0%-100%, and its contribution to your final score will depend on how it is weighted. 

    1) Quality performance category is weighted at 50%, meaning it contributes up to 50 points to your final score. If, for example, your quality score was 80%, it would contribute 40 points (80% of 50 points). This performance category evolved out of the Physician Quality Reporting System (PQRS). 

    2) Promoting interoperability (PI) performance category—formally know as advancing care information (ACI)—is weighted at 25%, meaning it contributes up to 25 points to your final score. For example, a PI score of 80% would contribute 20 points to your final score (80% of 25 points). However, if a PI exception applies, this contribution is reduced to zero, with quality’s contribution being reweighted upward. The PI category replaced the meaningful use (MU) program for electronic health records (EHRs). 

    Promoting interoperability (PI) was formerly known as advancing care information (ACI). CMS didn’t announce the name change until April 24, 2018, so you can expect to see the old ACI terminology on most 2018 MIPS resources.

    3) Improvement activities performance category is weighted at 15%, meaning it contributes up to 15 points to your final score. For example, an improvement activities score of 80% would contribute 12 points to your final score (80% of 15 points). In 2018, the requirements and scoring for this performance category are largely the same as they were in 2017. 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 performance category is weighted at 10%, meaning it contributes up to 10 points to your final score. For example, a cost score of 80% would contribute 8 points to your final score (80% of 10 points).  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.

    Note: In addition to the PI exceptions mentioned above, there are very limited circumstances where you may apply to have 1 or more of these 4 performance categories reweighted (see “Quakes, Fires, and Other Disasters!”).

    Table 1: 2018 MIPS Final Score

    Your MIPS final score is a composite score. It is typically based on your scores in 4 performance categories but would be based on 3 scores if you are excused from the promoting interoperability (formerly ACI) performance category. Less commonly, you may be excused from other performance categories.

    Performance Category Final Score’s Default Composition Final Score’s Composition if a Promoting Interoperability Exception Applies
    Quality 0-50 points 0-75 points
    Promoting interoperability (PI; formerly ACI) 0 or 12.5-25 points  
    + Improvement activities 0-15 points 0-15 points
    Cost 0-10 points 0-30 points
    = MIPS final score 0-100 points 0-100 points

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