>> Molly MacHarris: What is the scoring methodology for
the merit-based incentive payment system?
I'm Molly MacHarris with CCSQ, and I will be leading
you through this discussion.
So how exactly will we be scoring clinicians under the
MIPS program?
I will talk us through this, or I will take us through
this through the performance categories.
So let's start first with how we will score clinicians
under the quality performance category.
So, again, the performance requirements are that
clinicians would need to choose six measures out of a
set of close to 300.
Clinicians will receive points per measure.
Clinicians can receive between a range of three to
10 points per measure.
For measures where a clinician could have
reported or performed on a measure and they do not
clinicians would get a zero for that particular measure.
We also do have bonus points available under the quality
performance category to incentivize certain types of
measures and measurement activities.
The bonus points include measures that are outcome
based and measures that are -- deal with patient
experience, and we also have bonus points for clinicians
who participate in end to end reporting, using their
certified EHR technology.
So how exactly do we calculate the quality
performance category?
So we take the points that are earned under the six
quality measures.
Again, for each measure, it would range from three to 10
points, or zero points if nothing is received.
We would then add any bonus points, and then divide that
by the maximum number of points available, and that
would result in the quality performance category score.
So how would we calculate the cost performance category?
So, as I mentioned in previous training modules,
we are not measuring cost for the first year under the
MIPS program, but how we would calculate cost is that
clinicians could receive up to 10 points per
cost measure.
And the way that the cost performance category would
be calculated -- so very similar to quality, as we
would take all of the points that are received and then
divide that by 10 times the number of scored measures.
But, again, remember we are not calculating cost for the
first year.
So this is more just information on how we would
calculate the cost performance category for a
future year.
So how are we calculating the improvement activities
performance category?
Under the improvement activities performance
category, there are certain activities that clinicians
can choose from a set of over 90.
Each of those activities has a corresponding weight.
Those weights are either medium or high, and medium
weights count for 10 points.
High activities count for 20 points.
The majority of clinicians want to get to 40 points.
So clinicians can get to those 40 points by doing any
combination of medium or high activities, and then
for those clinicians under the improvement activities
performance category that receive special scoring, so
clinicians such as non-patient facing
clinicians, clinicians that are in rural or HPSA areas,
that are a part of small practices, they would --
their activities would be double weighted.
So what that means is that for those clinicians, their
medium activities would count for 20 points, and
their high activities would count for 40 points.
So, again, a similar mathematical equation to
what we have under the other performance categories.
We take the total number of points that were received,
divide that by the maximum number of points, times that
by 100, and that results in the improvement activities
performance category score.
And let's go to the next slide for advancing
care information.
So the advancing care information: this one is
calculated a little bit differently.
There are -- there is a base score, which counts for
50 percent.
There is a performance score, which -- there's 90
percent available, and then a bonus score, which is
15 percent.
That results in a 155 percent maximum score, which
would then be capped at 100, and then scaled to the 25
performance points available.
And you may be asking why 155 percent?
This structure was deliberately created to
ensure that clinicians have absolute flexibility to
focus on the measures that are most relevant to them
and their practices.
Goal under the advancing care information performance
category was to shift the concentration away from
measures that were not applicable.
So then to roll up the advancing care information
performance category score, again, it's that base score,
which is 50 points, the performance score, which is
90 points, and then the bonus score, which is 15
points, which results in 155 points, which would then get
scaled down to 100 to a total potential of 25 points.
So how do we actually calculate a final score for
MIPS eligible clinicians?
We take the performance category scores that are
earned under each of those performance categories, add
those up, multiply that by 100, and that would result
in a numerical score for each MIPS
eligible clinician.
So with these numerical scores, there're a couple of
numbers that are really important for everyone to be
aware of.
So starting at the bottom of this table, the number zero.
So clinicians whose final score is the number zero:
they would be receiving a negative 4 percent payment
adjustment in 2019.
This would be for clinicians who are eligible to
participate, but they do not do anything.
The next number that's important is the number three.
That is the MIPS performance threshold, and that is the
number that clinicians would need to hit to avoid a
negative payment adjustment, and if they hit that number
three, they would receive a neutral payment adjustment:
so no impact to their claims in 2019.
For clinicians' final scores that are above the number
three and go up to 69 points, they would be
receiving a positive MIPS adjustment, and then the
last number that's important is the number 70, and for
clinicians whose final score is at or above the number
70, not only would they be receiving a positive MIPS
adjustment for their participation, they would
also be receiving an additional positive
adjustment for exceptional performance.
This discusses the additional adjustment
factors for exceptional performance.
So we do have the ability for the first few years
under the MIPS program for clinicians to receive an
additional payment adjustment for
exceptional performance.
Again, this only applies for clinicians whose final score
is above the number 70.
Where can I go to learn more?
We have a lot of additional information for all
clinicians, stakeholders, everyone involved, who wants
to learn more about the quality payment program at
the quality payment program portal website, which is at
qpp.cms.gov.
We also have organizations on the ground that are
available to provide clinicians additional
information on how the quality payment program works.
A few that I want to call out include The Transforming
Clinical Practice Initiative or TCPI.
TCPI is designed to support more than 140,000 clinician
practices over the next four years in sharing, adapting,
and further developing their comprehensive quality
improvement strategies.
Clinicians participating in TCPI will have the advantage
of learning about MIPS and how to move toward
participating in advanced APMs.
We also have Quality Innovation Network and
Quality Improvement Organizations; so QIN QIOs.
The QIO programs: 14 QIN QIOs bring Medicare
beneficiaries, providers, and communities together in
data-driven initiatives that increase patient safety,
make communities healthier, better coordinate
post-hospital care, and improve clinical quality.
And if you are in an APM, the Innovations Center's
learning systems can help you find specialized
information about what you need to do to be successful
in the advanced APMs.
Thank you for viewing this presentation.
For more information please visit the quality payment
program website at qpp.cms.gov.