• MIPS 2018—Quality: You Can Earn an Improvement Percent Score

    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


    If you participated in MIPS in 2017 and earned a score for the quality performance category, you may be able to earn a quality improvement percent score for your 2018 performance.

    CMS checks whether your score for measure performance has improved. When comparing your 2018 score for quality with your 2017 score, CMS doesn’t include any bonus points and nor does it include your improvement percent score. For each of the 2 years, it assigns you a quality performance category achievement percent score, which it calculates by dividing your total measure achievement points by your total available measure achievement points.

    How CMS determines your improvement percent score. Your improvement percent score = ([your increase in quality performance category achievement percent score from 2017 to 2018] / your 2017 quality performance category achievement percent score) x 10. (See Table 8 for examples.)

    The improvement percent score is capped at 10%. If you doubled your measure achievement points, you would get the maximum score of 10%.

    You can’t get a negative score. If your performance declined, your improvement percent score would be 0%.

    You must fully participate in quality reporting for 2018. To be eligible for an improvement adjustment percent score, you must submit all the required measures and report on at least 60% of applicable patients for each measure.

    CMS sets a floor of 30% for your 2017 quality performance achievement percent score. In 2017, CMS allowed you to “pick your pace” of MIPS participation, which meant you could avoid the penalty by reporting 1 measure just 1 time. Consequently, an improved quality performance category achievement percent score in 2018 doesn’t necessarily reflect improved clinical performance; it could just mean that a clinician has increased his or her MIPS participation (e.g., the clinician reported 1 quality measure in 2017 and 6 in 2018). To address this, when comparing your quality performance category achievement percent scores for 2018 and 2017, CMS will assume a minimum score of 30% for 2017.

    CMS uses your MIPS identifier when comparing scores. When a practice’s clinicians report as a group, their MIPS identifier is the practice’s Tax Identification Number (TIN) alone; when they report individually, they each have their own MIPS identifier, which combines the TIN with their own National Provider Identifier (see Use of TINs and NPIs as Identifiers).

    What if your MIPS identifier changes? If your current MIPS identifier is different from your 2017 MIPS identifier, CMS will still try to evaluate whether you are eligible for an improvement adjustment. Suppose, for example, your practice reported as individuals in 2017 but reports as a group this year; CMS would calculate a group score for 2017 based on the average scores of the clinicians who are part of the group this year and would compare that score against your group score for 2018.

    Table 8: Calculating the Improvement Percent Score

    Three examples of how the improvement percent score is calculated. (Note: The quality achievement percent score = total measure achievement points ÷ total available measure achievement points.)

    Table 8A: Eligible Clinician #1

    2017 quality achievement percent score: 5%*
    2018 quality achivement percent score:    50%
    Increase from 2017 to 2018: 20%*
    Rate of improvement: 20 ÷ 30 = 0.67
    Improvement percent score: 0.67 × 10 = 6.7%
    *Although the 2017 score is 5%, the increase in performance is compared against a floor of 30%.

    Table 8B: Eligible Clinician #2

    2017 quality achievement percent score: 60%
    2018 quality achievement percent score: 66%
    Increase from 2017 to 2018: 6%
    Rate of improvement: 6 ÷ 60 = 0.10
    Improvement percent score: 0.10 × 10 = 1.0%

    Table 8C: Eligible Clinician #3

    2017 quality achievement percent score: 30%
    2018 quality achievement percent score: 70%
    Increase from 2017 to 2018: 40%
    Rate of improvement: 40 ÷ 30 = 1.3
    Improvement percent score: 1.3 × 10 = 13.3% (capped at 10%)

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

    Next: Quality: How CMS Calculates Your Quality Score.

    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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