Quality represents 60% of the MIPS Composite Performance Score in 2017. It replaces the Physician Quality Reporting System (PQRS) and the quality component of the Value-based Modifier (VM) program.

Clinicians need to choose 6 measures to report from a body of over 270 primary care and specialty-focused measures.  In addition, for practices of 1-9 clinicians (small groups) Medicare will use claims data to determine the quality of care provided for two population measures. There is no action required by clinicians to report on the two additional population health measures. 

For larger practices, those with 10 or more clinicians, Medicare will select three population measures.  Again, no additional action is needed by the practice to report on the three population measures. 

The population measures are worth up to 10 Quality Points.  Thus, small practices can achieve a maximum of 80 Quality Points, 10 from each of the 6 measure they choose to report and 10 from each of the population health measures calculated by Medicare.  Larger practices can achieve up to 90 points, 10 from each of the 6 measures their clinicians choose to report, and 10 from each of population health measures.

Clinicians will need to choose:

One outcome measure (if available) or another “high quality” measure

High quality measures are defined as measures related to:

  • Patient outcomes
  • Appropriate use of resources
  • Patient safety
  • Efficiency of care
  • Patient experience
  • Care coordination

Clinicians may also choose to report a “specialty measure set” instead of the 6 measures described above.

In summary, if a small practice achieves a score of 80 points then they will have achieved the highest possible score in the MIPS Quality Performance Category, which is 60% of the total Composite Performance Score.

Large practices will have to achieve a score of 90 points in the Quality Performance Category in order to reach the same score in the Quality Performance Category.

Challenges:  Unlike PQRS, which for most practices was a “pass-fail” program, measures under MIPS will place a premium on the level achieved for each measure.  For example, if a clinician only occasionally met the requirement for a quality measure under PQRS (e.g., smoking cessation counseling) but managed to report that a small number of patients had met the measure, they would still “pass” PQRS for that measure.  Under MIPS low reporting scores will result in low Composite Performance Scores and negative Medicare payment adjustments.

Recommendations:  First determine which 6 measures will be reported for each clinician.  Look for measures that a good fit for the volume in your practice and that do not create unnecessary burdens on your staff, patients, or workflows within your practice.  Make sure that you EHR vendor supports the measures you have chosen, or use alternative processes to capture measure denominators and numerators, such as automated reviews of documentation by a natural language processing engine tailored specifically to identify MIPS Quality Measures.  

Quality (a MIPS Performance Category)

​​MACRA University