Quality Performance Category
- Select 6 Measures
- 1 outcome or high-priority measure
- Alternatively, a specialty or sub-specialty measure set may be used
- Report 60% of applicable visits from a full calendar year
- Population measure automatically calculated, if applicable
Key Changes from 2017
Click each option to learn more!
60% of all patients must be reported on to satisfactorily report a measure.
In 2017, 50% of patients from all payers had to be reported on (80% for individual clinicians reporting via claims).
In 2018, 60% of patients from all payers must be reported on.
Measures that don’t meet the data completeness criteria earn 1 point (3 points for small practices).
In 2017, measures that didn’t meet the data completeness criteria earned 3 points.
In 2018, measures that don’t meet the data completeness criteria will earn 1 point. However, small practices (those with 15 or fewer eligible clinicians) will continue to be awarded with 3 points for these measures.
The 90-day performance period is no longer an option.
In 2017, providers had the option of reporting for a 90-day performance period.
In 2018, the performance period must be the entire calendar year.
Highly Topped-Out Measures
Six measures have been identified by CMS as "highly-topped out" and will have their total possible earned points capped at 7 points instead of 10 points.
- #21: Perioperative Care: Selection of Prophylactic Antibiotic—First OR Second Generation Cephalosporin
- #23: Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
- #52: Chronic Obstructive Pulmonary Disease (COPD): Inhaled Bronchodilator Therapy
- #224: Melanoma: Overutilization of Imaging Studies in Melanoma
- #262: Image Confirmation of Successful Excision of Image—Localized Breast Lesion
- #359: Optimizing Patient Exposure to Ionizing Radiation: Utilization of a Standardized Nomenclature for Computerized Tomography (CT) Imaging Description
Quality Performance Category Submission Options
An organization may choose to submit measure data to CMS as an individual or as a group through any the options below.
CMS Web Interface
CAHPS for MIPS Survey
What Contributes to the Quality Performance Category Score?
As Quality is worth 50% of your total MIPS composite performance score, understanding how to excel in this category is important. Measure performance compared to benchmarks, bonus points, and the types of measures you have selected all impact your Quality score.
1-10 Points per reported measure
Additional Outcome /
End-to-end electronic reporting
- Add together points scored and divide by 60 or 70 (for groups eligible for the All-Cause Hospital Readmission measure) to get the final quality score.
- If less than 6 measures are selected, clinicians will receive 0 points for missing measures.
- Quality measures that meet the minimum case requirement, data completeness threshold, and have a benchmark will be worth between 3-10 points. If a measure has no benchmark or does not meet the minimum case requirement, it will only receive 3 points.
- Bonus point categories are capped at 10% of the total possible quality score. This is 7 points for groups eligible for the All-Hospital Readmission Measure, and 6 points in all other circumstances.
Stay up to date with the latest news regarding MACRA and MIPS.
The Healthmonix Advisor is a free weekly news source, connecting you to the latest updates in the value-based care industry.