How to Profit From MIPS, Explained in Plain English

Elizabeth W. Woodcock, MBA, FACMPE, CPC


September 06, 2017

In This Article

MIPS Scoring: Different Points, Based on How You Sent in Your Data

For many physicians who participated in PQRS, those 20 records protected against penalties—and even provided bonus payments for several years of the reporting program. MIPS scores you on the basis of quality, which is where the program really differs from the PQRS.

Physicians are scored based on performance against benchmarks, not just for submitting data. The scoring in the MIPS Quality Performance Category is assessed against government-defined benchmarks to determine how many "points" that measure will earn for you.

The benchmarks themselves are specific to the type of submission method—EHR, registry, claims, et cetera—required for reporting that measure. Because the benchmarks are dependent on your reporting mechanism, you may receive different points on the basis of your methodology, even for the same score.

The goal is to capture 60 points—10 points for each of the six measures you report. With 60 points, you'll benefit from a perfect score in this aspect of the program, because the quality reporting is valued at 60% of the program.

As discussed, 70 is the score required for exceptional performance. Thus, gaining these 60 points is very valuable for your participation in the program.

Capturing all 60 points will be difficult, however, even for the most successful, organized, and prepared practice. To show why it's so challenging to capture a perfect score, let's examine what might occur with an often-selected quality measure: documentation of current medications in the medical record.

CMS defines this measure as the "percentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency, and route of administration."

This measure, unlike many others, can be reported by any mechanism offered—claims, EHR, registry, or QCDR. MIPS will formulate your score on the basis of your performance in relation to historic benchmarks. Because each benchmark is presented in terms of deciles, the percentage you report will be sorted by decile. For example, decile 4 equals 4-4.9 points; decile 5 equals 5-5.9 points; and so on. Decile 3 is the minimum decile for the MIPS program, with 3 points awarded just for submitting data for that measure.

A percentage of 99.21 is impressive—99.21 patients out of every 100 had their medications reconciled—but that score may be quite inadequate. In addition to the percentage itself, what makes the difference is how you reported that score. For example, you'd accrue only 4 points if you had submitted that score via claims (which is required for Medicare patients only), but you'd get 6 points if the score came in via a registry/QCDR. If you used EHR-based reporting, you'd receive 9 points.

Keep in mind that reporting via EHR or registry must include all patients who meet the criteria for the measure being reported, not just those covered by Medicare.

Many MIPS quality measures cannot be reported via all of the mechanisms available. For example, the popular measure "Closing the Referral Loop: Receipt of Specialist Report" can be reported by only a single methodology: EHR reporting.


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