2019 Quality Requirements

 

45% OF FINAL SCORE

This percentage can change due to Special Statuses, Exception Applications, reweighting of other performance categories, or Alternative Payment Model (APM) participation.

 

What Quality Data Should I Submit?

 

Merit-Based Incentive Payment System (MIPS) Quality Measure Data

Participants collect measure data for the 12-month performance period (January 1 - December 31, 2019). The amount of data that must be submitted depends on the collection (measure) type.

For electronic Clinical Quality Measures (eCQMs), MIPS CQMs (formerly "Registry measures"), Qualified Clinical Data Registry (QCDR) Measures, and Medicare Part B claims measures (only available to small practices), participants should:

• Submit collected data for at least 6 measures, or a complete specialty measure set; and

• One of these measures should be an outcome measure; if you have no applicable outcome measure, you can submit another high priority measure instead

• In addition, for groups of 16 or more clinicians who meet the case minimum of 200, the administrative claims-based all-cause readmission measure will be automatically scored as a seventh measure

An individual or group can submit any combination of measures across these collection types (eCQMs, MIPS CQMs, QCDR Measures, and for small practices, Medicare Part B claims measures) to fulfill the requirement to submit 6 measures. The CAHPS for MIPS Survey measure can also count as one of the 6 measures submitted.

 

Specialty Measure Sets

Clinicians and groups can choose to submit a specialty or subspecialty measure set. In doing so, they must submit data on at least 6 measures within that set. If the set contains fewer than 6 measures, the clinician or group should submit each measure in the set.

 

CAHPS For MIPS Survey

Groups and virtual groups that collect measures via various collection types (eCQMs, MIPS CQMs, QCDRs, CMS Web Interface, and for small practices, Medicare Part B claims) may also submit and be scored on the CAHPS for MIPS survey.

Groups will have their total available measure achievement points reduced by 10 points if they:

• Submit 5 or fewer measures; and

• Register for the CAHPS for MIPS survey but do not meet the minimum beneficiary sampling requirements

 

How Are Measures Scored?

Measure achievement points are determined by comparing performance on a measure to a measure benchmark.

If a measure can be reliably scored against a benchmark, it means:

• A benchmark is available; and

• Has at least 20 cases; and

• Meets the data completeness requirement standard, which is generally 60 percent

 

Bonus Points

Quality measure bonus points can be earned in the following ways:

• Submission of 2 or more outcome or high priority quality measures (bonus will not be awarded for the first outcome or high priority quality measure and will not be awarded for measures submitted via CMS Web Interface)

  • Opioid-related measures are now included in high priority quality measures

• Submission using End-to-End Electronic Reporting, with quality data directly reported from a certified EHR technology (CEHRT)

There are 6 bonus points added to the Quality performance category score for clinicians in small practices who submit at least one measure, either individually or as a group or virtual group.

Clinicians can also earn up to 10 additional percentage points based on their improvement in the Quality performance category from the previous year.

 

When Will Facility-Based Measures Scoring Apply?

Beginning with the 2019 Performance Period, we will identify clinicians and groups eligible for facility-based scoring. These clinicians and groups may have the option to use facility-based measurement scores for their Quality and Cost performance category scores.

Facility-based measurement scoring will be used for your Quality and Cost performance category scores when:

• You are identified as facility-based; and

• You are attributed to a facility with a Hospital Value-Based Purchasing (VBP) Program score for the 2019 performance period; and

• The Hospital VBP score results in a higher score than the MIPS Quality measure data you submit and MIPS Cost measure data we calculate for you

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