• MIPS 2018—Quality: Your Performance Rate Will Be Compared Against a Benchmark

    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 report a quality measure, CMS first determines whether you met (1) the case minimum requirement (at least 20 patients) and (2) the data completeness criteria (at least 60% of applicable patients). If you did, CMS will give you an achievement score based on your performance.

    Your achievement score (3-10 points) for a measure will depend on how you perform against the measure’s benchmark. There are separate benchmarks for claims-based reporting, for reporting via manual data entry into a registry portal, and for EHR-based reporting (whether via IRIS Registry integration or via your EHR vendor).

    Each benchmark is broken into deciles, and the number of achievement points you receive will depend on which of those deciles you fall into:

    • If you fall within the first 2 deciles, you will receive 3 achievement points if in a small practice; if in a large practice, you score 1 or 3 achievement points, depending on whether you meet the data completeness criteria.
    • If you fall in deciles 3 through 9, you will receive partial achievement points depending on where you fall within that decile. (For instance, if you fall in the ninth decile, you could receive 9.0-9.9 points.)
    • If you fall within the 10th decile, you’ll receive the full 10 achievement points.

    Some measures are inverse measures. With an inverse measure, a higher percentage indicates a worse performance. An example would be, Measure 1: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%).

    Table 7: Benchmarks for Quality Measure 12—POAG: Optic Nerve Evaluation

    How many achievement points you score for a quality measure—in this case MIPS measure 12—will depend on how your performance rate compares to a benchmark. There are different benchmarks for claims-based reporting, EHR-based reporting (whether via IRIS Registry/EHR integration or via your EHR vendor), and manual entry via the IRIS Registry web portal (no EHR needed). For this measure, the performance rate represents the “percentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during 1 or more office visits within 12 months.”

    Table 7A: Benchmark for Reporting by Claims

    Decile Benchmark Points
    3 98.99 - 99.99 3.0-3.9
    4-9 Topped out  
    10 100 10

    Table 14B: Benchmark for Reporting by IRIS Registry/EHR Integration or EHR Vendor

    Decile Benchmark Points
    3 82.75-87.40 3.0-3.9
    4 87.41 - 90.76 4.0-4.9
    5 90.77 - 93.62 5.0-5.9
    6 93.63 - 96.16 6.0-6.9
    7 96.17 - 97.87 7.0-7.9
    8 97.88 - 98.96 8.0-8.9
    9 98.97 - 99.99 9.0-9.9
    10 100.00 10

    Table 14C: Benchmark for Manual Reporting Using the IRIS Registry Web Portal

    Decile Benchmark Points
    3 94.07 - 98.14 3.0-3.9
    4 98.15 - 99.16 4.0-4.9
    5 99.17 - 99.99 5.0-5.9
    6-9 Topped out  
    10 100 10

    October’s ICD-10 Updates Could Reduce the Performance Period for Some Measures

    On Oct. 1, CMS updates the ICD-10 code set—and this could have repercussions for quality measures. The quality performance category relies on ICD-10 codes (the diagnosis codes) to determine which patients are eligible for each quality measure. However, CMS updates the ICD-10 code set annually on Oct. 1, which is 75% of the way through the MIPS performance year. In some cases, these changes to the ICD-10 code set may mean that it would no longer be fair to compare your performance on a measure to its historical benchmark—you would be comparing apples to oranges.

    Quality measures that are significantly impacted by ICD- 10 changes will be subject to a 9-month assessment. After CMS has determined what changes will be made to the ICD- 10 code set, it will determine whether any quality measures are significantly impacted by those changes. It will publish a list of those measures on the CMS website at some point between Oct. 1, 2018, and Jan. 2, 2019. For the measures on that list, CMS would only evaluate your performance for those measures based on the first 9 months of 2018, before the ICD-10 codes were changed.

    UPDATE: Due to ICD-10 changes that went into effect on Oct. 1, 2018, you just submit data for the first 9 months of 2018 for Measure 137: Melanoma: Continuity of Care—Recall System, Measure 138: Melanoma: Coordination of Care, and Measure 224: Melanoma: Overutilization of Imaging Studies in Melanoma.

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    Previous: Quality: Meet the 2 Data Submission Thresholds

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

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