The MIPS Quality performance category replaces and incorporates components of the Physician Quality Reporting System (PQRS) and the Physician Value-based Payment Modifier (VM). The goal of the Quality category is to help improve the quality of patient care by measuring health care processes, outcomes, and patient perceptions, and to use this data to provide feedback and incentives to clinicians.
For the 2017 performance year, Quality accounts for 60% or 85% of the overall MIPS Performance score, depending upon whether a clinician or group qualifies for reweighting the Advancing Care Information (ACI) category. For those who qualify, such as non patient-facing clinicians, the ACI weight of 25% is added to the base 60% weight for Quality, bringing the overall Quality weight to 85%. See ACI Performance Category Requirements for more information.
For the 2017 transition year, MIPS-eligible clinicians have options for the quality performance category, including
deciding to participate individually or as a group;
choosing how much data to submit, also known as “Pick Your Pace”; and
choosing which data submission mechanism to use.
Individual and Group Participation
MIPS-eligible clinicians have the option to participate individually or as a group.
Individual participation means a clinician receives payment adjustment and feedback based on their individual performance. The clinician is identified by their National Provider Identifier (NPI) which is tied to a Taxpayer Identification Number.
Group participation means each clinician in the group is evaluated equally, with payment adjustment and feedback aggregated and determined by the group’s performance. Reporting is done through a single group TIN, with at least two MIPS-eligible clinicians identified by NPI and who have reassigned their Medicare billing rights to the group TIN.
Pick Your Pace
Clinicians can choose from three participation levels for the transition year:
Test allows clinicians to receive neutral or small payment adjustment by submitting just one measure from any category – e.g. just one quality measure or improvement activity.
Partial Year participants can report for a 90-day period to qualify for a small positive payment adjustment.
Full Year participants can qualify for a moderate positive payment adjustment by submitting data for the January – December 2017 performance year.
Data Submission Mechanisms
Clinicians have multiple options for submitting data:
How it Works
Qualified Clinical Data Registry (QCDR)
A QCDR is a CMS-approved entity that collects medical and/or clinical data to track patients and disease. NRDR is a CMS-approved QCDR, with custom quality “Non-MIPS” measures specially developed for radiology.
A qualified registry collects clinical data and submits it to CMS on behalf of MIPS-eligible clinicians. Qualified Registries must be approved by CMS, and can only report MIPS measures defined by CMS.
Electronic Health Record
Clinicians submit data to CMS directly through their EHR system or a qualified health IT vendor submits the data for them.
Clinicians pick measures and report through their routine billing processes. If they choose this option, they need to add certain billing codes to denominator eligible claims to show that the required quality action or exclusion
CMS Web Interface
A secure internet-based application available to preregistered groups of 25 or more MIPS eligible clinicians. CMS partially pre-populates the CMS Web Interface with claims data from the group’s Medicare Part A and Part B beneficiaries who have been assigned to the group. Then, the group completes the clinical data for the pre-populated Medicare patients.
For the transition year, registration was April 1 through June 30, 2017.
Quality Measures and Requirements
For Radiology, there are 56 MIPS and 24 non-MIPS quality measures for the 2017 performance year, grouped into three classifications:
Process measures show what doctors and other clinicians do to maintain or improve health, either for healthy people or those diagnosed with a given condition or disease. These measures usually reflect generally accepted recommendations for clinical practice, such as the percentage of people getting preventive services, such as mammograms.
Outcome measures show how a health care service or intervention influences the health status of patients. For example, the percentage of lung cancer screenings interpreted as positive.
High priority measures include the following categories:
To meet Full Year requirements, clinicians must
Report at least 6 measures for at least 50% of the eligible provider’s applicable patients seen from January 1, 2017 thru December 31, 2017.
Report on at least one outcome measure. If one outcome measure is not available, then report on a high priority measure.
If an individual clinician or group decides to report fewer than the six required measures or if no outcome/high priority measure is reported, this will trigger the Eligible Measure Applicability (EMA) process so CMS can investigate and see if there are other measures that should have been reported.
More information is available on the 2017 MIPS measures and QCDR (Non-MIPS) measures in Review Available Measures or you can navigate the MIPS Measure Calculator.
Based on your performance, you’ll get 3 to 10 measure points for each quality measure you submit if the measure can be reliably scored against a benchmark.
Bonus points are available for:
End-to-end reporting: Clinicians receive one bonus point if they report their quality data directly from their EHR to a qualified registry, QCDR, or via the CMS Web Interface.
Submitting additional measures: Clinicians can get one bonus point for each high priority measure and two bonus points for each additional Outcome and Patient Experience measure.