The MIPS Quality performance category will account for 40 percent of an eligible clinician's composite score in performance year 2021 (payment year 2023).
Measure-specific benchmarks, based upon a measure's performance rate, are established by CMS to determine an eligible clinician's score on the 10-point scale. CMS will award points to eligible clinicians based on benchmarking performance rates. Each benchmark must have a minimum of 20 MIPS eligible clinicians who reported the measure for at least 20 cases. Benchmarks are updated based on performance in the previous year. Same year benchmarking is available when a historical benchmark cannot be used and the minimum criteria described above are met.
Scoring of quality measures are based upon benchmarks and data completeness under a three-class system:
- Class 1: ECs and groups may receive 3-10 points per measure if the EC or group submits on a measure that can be benchmarked, includes at least 20 cases and meets the 70% data completeness threshold.
- Class 2: ECs and groups will receive 3 points per measure if the EC or group submits on a measure meeting the 70% data completeness threshold but do not have either a benchmark or includes at least 20 cases.
- Class 3: ECs and groups other than small practices will receive zero measure achievement points while small practices will continue to receive 3 points for measures that do not meet the data completeness threshold, even if they have a measure benchmark and/or meet the case minimum.
Topped Out Measures
Measures that are determined to be “topped out” or cannot demonstrate meaningful distinctions of improvement between clinicians, will be subject to special scoring and will be removed from MIPS based on 4-year phasing out process. Topped out measures that have a benchmark and are topped out for at least two consecutive years can earn up to 7 points, instead of 10. However, measures determined to be "extremely topped out" with mean performance rates between the 98th and 100th percentile are not subject to the 4-year removal timeline and can be removed the following year through rulemaking.
CMS will award bonus points for reporting additional high-priority and outcome measures submitted above initial reporting requirements. Six bonus points are added to the Quality performance category score for clinicians in small practices who submit at least 1 measure, either individually or as a practice or virtual group. This bonus is not added to clinicians or groups who are scored under facility-based scoring. An EC or group can also earn up to 10 additional percentage points based on their improvement in the Quality performance category from the previous year.