As discussed in a recent article (“Value-based pay in 2017: Where does urology fit?"), most U.S. urologists will be subject to the Merit-Based Incentive Payment Program (MIPS) in performance year 2017/payment year 2019. For 2017, the Quality category in MIPS contributes 60% of the final weight to the MIPS composite score, and therefore provides the most opportunity/risk for eligible clinicians. In later years of MIPS, the Quality category drops to 30% weight.
Although the final rule contained several modifications that introduced “leniency” in this first year, many urologists want to optimize their performance in preparation for future years under MIPS. In this article, I will describe what urologists need to know about the Quality category and nuances of the scoring methodology.
The progenitor of the MIPS Quality category is the Physician Quality Reporting System (PQRS), and most of the available MIPS Quality measures are inherited from the PQRS program. Many physicians have been subject to payment adjustments under PQRS but have not thoroughly explored their performance on these measures until now. The key to understanding Quality measures and the contribution to scoring is the concept of benchmarking and grouping performance into deciles.
How benchmarks, deciles work
The Centers for Medicare & Medicaid Services has calculated separate benchmarks for each MIPS measure where there is reporting experience under the PQRS program in 2015; on Dec. 26, 2016, those benchmarks were released and are available online at bit.ly/qualityresources. If a measure can be reported by different submission methods, the benchmarks are calculated separately for each submission method (for example, claims, EHR, registry reporting). The benchmarks are calculated on a percentile basis and grouped into 10 deciles.
Under MIPS, your performance for 2017 will be matched to the benchmark decile and will determine the number of points achieved for that measure. While some measures have a “normal distribution” of benchmarks across those deciles, other measures have clustered benchmarks at the high or low end. Many of the oldest measures have very high performance benchmarks because physicians in PQRS have performed well with experience over many years; CMS defines these measures with a median benchmark over 95% as “topped out,” and this has significant implications for the MIPS Quality scoring. Finally, for new MIPS Quality measures, the benchmarks will be determined retrospectively once the 2017 performance data are available.