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MIPS - Scoring

The MIPS scoring will be a composite score of the 4 performance categories:

  • Quality – worth 50% of the total. Must report on 6 measures worth up to 10 points each and scored against benchmarks.  Bonus points for reporting an additional outcome or high-priority measure and for end-to-end reporting. 
  • ACI – worth 25% of the total.  Base score is worth 50 points, and performance plus bonus score potential points are 155, but with a maximum score of 100 (base+performance+bonus)
  • Improvement Activities – worth 15% of the total MIPS score.  Clinicians or groups must earn a total of 40 points.  High weighted activities are worth 20 points and medium weighted activities are worth 10 points.  Small, rural, or HPSA clinicians or groups earn double points.
  • Cost – worth 10% of the total score. Maximum score is 10 points for either TCC or MSPB, or the average of the 2 measures calculated by CMS.

Clinicians or groups must earn at least 15 points across all categories in order to avoid penalties and remain neutral.  

2018 Final Score 2018 Payment Adjustment
≥ 70 points
  • Positive adjustment
  • Eligible for exceptional performance bonus
16-69 points
  • Positive adjustment
15 points
  • Neutral adjustment
0-14 points
  • Maximum -5% adjustment (depends on score between 3.76-14 points; <3.75 gets -5%)
  • 0 points = does not participate

Thus below is how to a minimum of 15 performance points to achieve a neutral adjustment:

Quality Improvement Activities Advancing Care Info
Submit 6 measures that meet data completeness  Report 2 high-weighted or 4 medium-weighted activities for 90 days Meet Base Score plus 1 quality measure (OR 1 performance measure)
  Report 1 medium weighted activity PLUS ACI Base Score Report 1 medium weighted activity PLUS ACI Base Score
Small practices: Report enough quality measures to achieve 10 points (in addition to the 5 automatic points). Example: score well on 2 complete measures and submit 4 other incomplete measures. Small practices: 1 high-weighted or 2 medium-weighted activities for 90 days Small practices: Base score plus enough quality measures to achieve 5 points. 

For the 2018 performance period, there are new ways to earn bonus points:

  • Complex patient bonus – 1-5 bonus points toward the composite score calculated as an average HCC risk score
  • Small practice bonus – Practices with ≤ 15 clinicians automatically earn 5 bonus points so must earn at least 10 points in 1 performance category