• MIPS 2018—Quality: Watch for Measures That Are Topped Out

    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


    When you perform measures in the quality performance category, your performance rate will be compared against a benchmark. Some benchmarks reach, or almost reach, the maximum performance value well before the 10th decile. These are known as topped out measures.

    Topped out measures can be hazardous to your quality score. When a benchmark is topped out, you need a perfect performance rate to score maximum achievement points. If your performance is less than perfect, there is a ceiling on your maximum achievement score—for example, with measure 12 (see Table 7), if your performance is not perfect the ceiling is 3.9 achievement points for claims-based reporting and 5.9 achievement points if reporting via the IRIS Registry web portal.

    Topped out or not topped out? Some measures are both. Because there are different benchmarks for different reporting mechanisms, some measures are topped out for 1 reporting mechanism but not others.

    Maximum achievement score is 7 or 10 points. For most topped out measures, the maximum achievement score is 10 points. However, CMS has identified 6 measures—including measure 224 for overutilization of imaging studies for melanoma—where the maximum achievement score will be 7 points. (For the 2019 performance year, this 7-point cap will be applied to all benchmarks that have been topped out for 2 or more consecutive years.)

    Why CMS frowns on measures that are topped out. CMS is concerned that topped out measures provide very little room for improvement for most of the MIPS eligible clinicians who use those measures.

    The end of the line for some topped out measures. If a measure is topped out for a given reporting mechanism for 3 consecutive performance years, it will cease to be an option for that reporting mechanism in the fourth year. For most measures, the earliest that might happen is 2021, but measure 224 (Overutilization of Imaging Studies for Melanoma) has been flagged by CMS for special treatment and could be removed as early as 2020. The Academy has urged CMS to only remove topped out measures if replacement measures are available.

    Fortunately, CMS allows QCDRs, such as the IRIS Registry, to adjust their QCDR measures annually, which may enable the Academy to fine-tune the specifications of topped out QCDR measures so they are no longer topped out.

    Which measures are topped out?  Table 11 (PDF) provides an at-a-glance guide to the quality measures, including which measures have benchmarks that are topped out (and at which decile), which measures lack a benchmark, and which measures can earn you high priority bonus points. In that PDF, you can click on measure titles to access detailed web pages for those measures.

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    Previous: Quality: Watch for Measures That Don’t Yet Have Benchmarks.

    Next: Quality: Bonuses for High-Priority Measures and CEHRT.

    Note: 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.

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