2019 MIPS

Quality Performance Category

  • 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
45 %
MIPS Final Score


Key Changes from 2018

Click each option to learn more!

Quality comprises 45% of the MIPS final score.

Small Practice Bonus of 6 points will be included in the Quality Performance Category.

Submit multiple types of quality measures.

Topped Out Measures

Six measures were identified by CMS in 2018 as "topped out" and had their total possible points capped at 7 points instead of 10 points.  There will be additional measures added to this list in early 2019.  Starting in 2019, measures will be capped at 7 points if their benchmarks remain topped out for 2 consecutive years. 

  • #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 of the options below.

Collection Type

Individual Submisson

Group Submission

Clinical Quality Measures ( Formerly Qualified Registries)

QCDR Measures

Electronic Clinical Quality Measures (Formerly EHR Measures)

Medicare Part B Claims*

CMS Web Interface

CAHPS for MIPS Survey

Administrative Claims

*Medicare Part B claims measures can only be submitted by clinicians in a small practice (15 or fewer eligible clinicians) whether participating individually or as part of a group.

What Contributes to the Quality Performance Category Score?

As Quality is worth 45% of your total MIPS composite performance score, understanding how to excel in this category is important. Measure performance compared to benchmarks, bonus points, performance improvement, and the small practice bonus will all impact your Quality score.

PERFORMANCE

  • 1-10 Points per reported measure

+

BONUS

  • Additional Outcome/ High-Priority Measures
  • End-to-end electronic reporting
  • Small Practice Bonus
  • Performance Improvement

  • ​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 (20 eligible instances), 60% 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.  If a measure does not meet the data completeness threshold of 60%, it will only receive 1 point or 3 points (small practices).     
  • 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.

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