Merit-based Incentive Payment System (MIPS)

Graphic 1: MIPS Performance Category Weights for 2017

Graphic 1: MIPS Performance Category Weights for 2017

The MIPS Composite Score is composed of four components. The 2017 performance/2019 payment score will reflect the following category percentages:

  1. Resource Use – 10% 
  2. Quality – 50% 
  3. Clinical Practice Improvement Activities – 15%
  4. Advancing Care Information – 25%

The Composite Score Guide is a one-page reference sheet which includes links to all of the composite score measures, how they are submitted and how they are scored for the 2017 Performance/2019 Payment year.

Resource Use

Resource Use will be calculated from claims data, clinicians will not need to submit any data. Each resource measure is worth 10 points and a clinician’s score will be the average of all resource measures that can be attributed.
If objectives and measures are not applicable to a specialty, this category will be zero weighted and other MIPS categories will be adjusted to make up the difference. 

Quality

Clinicians will choose six quality measures, each measure is worth 10 points. Population measures will come from claims data; two for small practices defined as those having up to nine clinicians, and three for larger practices. Clinicians may choose the measures individually, or choose a set of measures specific to their specialty. Links to the measures are below.

Clinical Practice Improvement Activities (CPIA)

Clinicians will receive automatic full credit of 15 percent in 2017, in the MIPS clinical practice improvement activities category for participating in a CMS recognized PCMH model. As proposed, these include:

  • PCMH accreditation programs by the:
    • Accreditation Association for Ambulatory Health Care
    • National Committee for Quality Assurance (PCMH or Patient-Centered Specialty Recognition)
    • The Joint Commission
    • URAC
  • Certain Medical Home Models that meet defined criteria and are administered under Medicare or Medicaid

The Clinical Practice Improvement Category is worth 15% of the MIPS composite score in the first year of the program. If a clinician is not in a CMS recognized PCMH practice model, they can complete Clinical Practice Improvement Activities (CPIAs) to achieve points. 

Clinicians will need to participate in three high-weighted CPIAs (20 points each) or six medium-weighted CPIAs (10 points each), or a combination of high and medium-weighted CPIAs in order to achieve a total of 60 points and receive full credit. The link below contains the proposed CPIAs and is searchable by Category and Weight.

Advancing Care Information (ACI) 

Advancing Care Information was formerly the Meaningful Use (MU) program. This category is based on MU Modified Stage 2 measures (for 2014 Edition CEHRT) and MU Stage 3 measures (for 2015 Edition CEHRT). 

There are 131 total points available in the ACI category. Scores or 100 or more points will earn the full 25 percent toward the MIPS composite score while less than 100 points will result in partial credit. 

Base Score (50 points) from six objectives: Must be met before credit for performance points are earned
1. Protect patient health information (yes/no) Required for ANY base score
2. Patient electronic access (numerator/denominator)
3. Coordination of care-patient engagement (numerator/denominator)
4. Electronic prescribing (numerator/denominator)
5. Health information exchange (numerator/denominator)
6. Public health and clinical data registry reporting (yes/no)

Performance Score (80 points)
1. Patient electronic access
2. Coordination of care-patient engagement
3. Health information exchange

Bonus Score (1 point)
Report on a public health registry beyond immunizations

ACI Example

An example of the ACI score from the proposed rule is below. There are eight measures under these three Performance Score objectives. Each is assigned a total of 10 possible points. A clinician may earn up to 10 percent of their performance score based on their performance rate for these measures.  For example, a performance rate of 95 percent on a measure earns 9.5 percentage points. Table 1 is an example of scoring for the Performance Score.

The clinician’s overall advancing care information performance score, is the sum of the base score, performance score, and the potential bonus point. There are 131 points available, and scores of 100 or more qualify the clinician for the full 25 percent credit for the ACI category in the composite score. Scores of less than 100 are given percentage credit.

If objectives and measures are not applicable to a specialty, this category will be zero weighted and other MIPS categories will be adjusted to make up the difference. 

Recommendations for Clinicians

  • Become knowledgeable about the financial and reputational impacts of the Quality Payment Programs 
  • Analyze your Meaningful Use, PQRS, and VBM measures and benchmarks and attempt to estimate your MIPS Composite Score, these will account for 75 percent of the 2017 performance/ 2019 payment year.
    • Adopt Certified Electronic Health Record Technology (CEHRT), review Modified Stage 2 requirements for 2017 and prepare for Stage 3 in 2017
    • Report to the Physician Quality Reporting System (PQRS)
    • Download your Quality Resource and Use Report (QRUR) from CMS and identify opportunities for improvement.
  • Use the MAG website and the Composite Scoring Guide to see which quality and clinical practice improvement measures your practice can do and do well at.
  • Plan organizationally how to be successful in MIPS measures.