MIPS Composite Score 101: How you will be scored under the Merit-Based Incentive Payment System

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The Merit-Based Incentive Payment System (MIPS) is part of the new Quality Payment Program under MACRA and combines requirements previously included in three separate programs administered by the Centers for Medicare and Medicaid Services (CMS): the Physician Quality Reporting System (PQRS), the Medicare EHR Incentive Program (Meaningful Use), and the Value-Based Payment Modifier.

In the final rule, CMS estimated that around 600,000 providers will end up being evaluated under the requirements of the MIPS program, so it is important that Medicare physicians and providers who meet the definition of a MIPS eligible clinician understand the criteria for scoring and applying payment adjustments under MIPS.

MIPS requirements vary by performance category

MIPS is comprised of four performance categories, each with their own reporting requirements and associated maximum point totals. In 2017, data in each category must be submitted for at least one continuous 90-day period, and each category can be reported for a different 90-day period.

Below we outline the high-level requirements for each of the four performance categories included in MIPS.

Performance Category Requirements
Quality
  • Report six measures to CMS that best reflect the clinician’s practice, one of which must be an outcome measure or another high-priority measure if no outcome measure is available.
  • Clinicians may also choose to report a specialty measure set, which may include fewer than six measures. If the specialty measure set includes more than six measures, clinicians can choose six measures from the set that meet the above requirements.
Advancing Care Information
  • For this category, physicians and other clinicians must use certified EHR technology and will report a customizable set of measures that reflects how they use EHR technology in their day-to-day practice, with a particular emphasis on interoperability and information exchange.
  • To receive the base score (up to 50 points), physicians and other clinicians must provide the numerator/denominator or yes/no for five base measures.
  • The performance score (up to 90 points) will be based on performance on measures that matter most to clinicians.
  • Bonus points are available for reporting to public health and clinical data registries, and for reporting improvement activities using CEHRT.
Improvement Activities
  • Clinicians can choose the activities best suited for their practice from a list of over 90 activities aimed at supporting broad aims within healthcare delivery, such as care coordination, beneficiary engagement, population management, and health equity.
Cost
  • CMS will calculate these cost and utilization measures based on claims and availability of sufficient volume.
  • Clinicians do not need to report anything, and Cost measures will not impact the Composite Performance Score for the 2017 performance year.
  • For the 2017 performance year, clinicians will be evaluated on all cost measures applicable to their practice based on submitted Medicare Part B claims and will receive performance feedback to inform clinicians for future years when Cost category scores will contribute to the Composite Performance Score.
  • Cost measures include: Total per Capita Costs for All Attributed Beneficiaries, Medicare Spending per Beneficiary and up to 10 other episode based measures, with attribution to a group (TIN) or individual (TIN/NPI).

Additional information on reporting requirements across the four performance categories can be found here.

A unified scoring system

CMS is instituting a “unified scoring system” for MIPS that differs from how previous Medicare quality programs were evaluated in several ways:

  • Measures and performance in each MIPS performance category will be converted to points
  • Eligible clinicians will know in advance what they need to do to achieve top performance
  • Partial credit is available. For example, a clinician who submits four out of six required quality measures can receive credit for the four submitted.

The MIPS unified scoring system results in calculating a Composite Performance Score for all participating clinicians that represents performance in the four categories on a scale of 0-100 points. Each performance category is assigned a weighted value, which can change each performance year. The MIPS scoring methodology is also intended to take into account situations of exceptional performance, evaluation at the group or individual provider performance level, and the special circumstances of small practices, practices located in rural areas, and non-patient- facing MIPS eligible clinicians.

Methodology calculating overall performance in 2017

The table below outlines the evaluation criteria for each performance category and describes the maximum points and that category’s percentage of the overall MIPS Composite Score for the 2017 Performance Year.

Performance Category Scoring Methodology Maximum Points % of overall MIPS Score (2017)
Quality
  • Each measure for which data is submitted is worth 3-10 points compared to benchmarks based on historical data (if available) or data from the performance year.
  • Zero points will be given for a measure that is not reported (e.g. if the provider reports five measures instead of six, they can earn points for the measures submitted but will receive zero points for the missing measure).
  • Bonus points are available for reporting additional measures in certain categories, as well as for EHR reporting.
  • The category score is calculated by summing the point value for all activities and dividing by the highest potential score of 60 or 70 points, depending on group size.
  • There is a minimum floor of three points earned for all quality measures submitted in 2017.
60-70 points depending on group size  60%
Advancing Care Information
  • A base score of 50 points is earned by reporting at least one use case for each of the five required base measures.
  • Up to 10 additional performance points can be earned for each available measure, based on the measure performance rate (for a maximum of 90 additional points).
  • 15 bonus points are available.
  • A total cap of 100 points are available (base score + performance score + bonus points).
100 points 25%
Improvement Activities
  • Over 90 improvement activities are categorized into high- and medium-weighted activities.
  • Medium-weight activities are worth 10 points each.
  • High weight activities are worth 20 points each.
  • The point value for all activities is summed and compared against a maximum potential score of 40 points.
  • Clinicians participating in medical homes earn full credit in this category, and those participating in Alternative Payment Models will earn at least half credit.
 40 points  15%
Cost
  • CMS will assign 1 to 10 points for each applicable measure based on performance against benchmarks.
  • Clinicians and groups will be evaluated on all measures in this category applicable to their submitted Medicare Part B claims and performance feedback will be provided in 2017 for informational purposes.
  • The final cost performance category score is the equally-weighted average of all scored costs measures.
  • CMS will not calculate a cost performance category score if a clinician or group is not attributed any cost measures because the clinician or group has not met the case minimum requirements.
Maximum of 10 points on each applicable cost measure  0%

Aiming for the top

In 2017, a Composite Performance Score of three points will ensure that an eligible clinician or group will avoid a negative payment adjustment. Three points can be earned by reporting at least one quality measure, at least one improvement activity, or all five base measures in the Advancing Care Information category. Though it is relatively easy to avoid a negative payment adjustment in 2017, there is still a reason to strive for stellar performance. Exceptional performers who achieve a MIPS Composite Performance Score of at least 70 out of 100 will be eligible for an additional positive adjustment from a bonus pool of $500 million.

What is your organization doing to prepare for MIPS? Do you know what you need to do to achieve your highest performance? Sign up for our monthly newsletter to stay up to date on MIPS.


Further reading:
Should I just do the minimum? 3 Reasons clinicians and groups are going all out in MIPS this year
MIPS Advancing Care Information: Frequently Asked Questions

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