Blog - All Posts

iSALUS Healthcare Blog

Welcome to the iSALUS Healthcare blog. Providing informative Healthcare IT insights to help Physicians practice medicine.

Renae Rossow
Renae Rossow
Understanding MACRA and the Quality Payment Program Part 6

Understanding MACRA and the Quality Payment Program Part 6

At this point, our Understanding MACRA series has walked you through the four categories of the MIPS payment track of the Quality Payment Program (QPP). You’ve learned how many points you need to earn in each category and how you are scored. But how are those categories brought together for your total Composite Performance Score (CPS)? This question has a couple of different answers thanks to the first year being a “pick your own pace” year. First, we’ll take a look at how scores will be compiled in 2017, and then we’ll look at how future years will be calculated so you have an idea of what the future looks like under the QPP. 

Scoring for 2017

There are several things to consider for the 2017 Performance Year. Mostly, your scoring method will be based on the participation option that you choose.  Most importantly, for those who choose not to participate at all, make note that you will definitely receive a 4% negative payment adjustment in 2019. If you want to avoid the negative payment adjustment, you’ll need to choose one of the options below, and you’ll be scored accordingly.

Before we go into those options and the scoring methodology, it’s important that you know that for the 2017 performance year only, CMS has already determined the performance threshold to be 3 points. This means you need to do very little in order to avoid that negative payment adjustment. If you earn more than 3 points, you win!  See below for the specifics. 

  1. Test Option. The first participation option is the test option which simply means that for one day occurring in 2017 you will pull a 20-patient sample of data for one quality measure under the MIPS payment track. Don’t want to do that? Okay. You can alternatively choose to participate in one improvement activity.  No? Okay again. Your last choice is to report for everything under the Advancing Care Information category for MIPS. This is the category that replaces Meaningful Use. If you’ve done well in the past for Meaningful Use, then this might be the best option for you. By choosing any of these three activities under the test option, you will earn 3 points. Basically, you’ll break even with the performance threshold and completely avoid the negative payment adjustment. Unfortunately, you will not earn a positive payment adjustment and most definitely will not earn a bonus payment.  If you’re okay with that, then this is the option for you.

  2. 90 Day Reporting. This option means that for any 90 consecutive days occurring in 2017, you will collect all of the data required for all four of the categories under the MIPS payment track of the QPP and send that data to CMS during the reporting period which takes place between January 1, 2018, and March 31, 2018. Each category will be scored independently and then combined together for your total composite score. Next, CMS will add every score from every provider and average them out. Once that average is found, that will become the new performance threshold. Don’t worry, by submitting for this option you’ve already met the 3 points required to avoid the negative payment adjustment so you’re safe. However, in order to determine your positive payment adjustment, CMS needs to know where you ranked compared to other providers. How high above 3 in comparison to other providers will determine your positive payment adjustment. If you do really well, then you might even qualify for a bonus payment. This is money set aside by CMS for those who really performed well under the MIPS payment track.  If you ranked in the top 25% you will get a bonus payment. How much that payment is, will be determined by where you ranked in the top 25% overall.

  3. Full Year Reporting. This is for those who were ready to run by January 1, 2017. If you’ve already picked the quality measures, improvement activities and had everything ready to go for the Advancing Care Information category then you might have chosen this option. Just like the 90-day option, every category will be scored independently and then added together for your total Composite Performance Score. Based on how well you did when compared to other providers, this will determine your positive payment adjustment. The same goes for the potential bonus payment. If you ranked in the top 25% you will receive a bonus payment based on where you ranked. 

When it comes to adding each category score together for both the 90-day option and the full-year option, you should consider the weight of the categories for the year 2017. This weighting is relative over time and will be changing by 2018.

              Quality Category = 60%

              Improvement Activities = 15%

              Advancing Care Information = 25%

Let’s say you scored the following: 

  1. Quality Score = 60 of 80 possible points
  2. Improvement Activities = 35 of 40 possible points
  3. Advancing Care Information Score = 100 of 100 possible points.

If you consider the weight above, your total Composite Performance Score would be 82.9 or 83%. Even though you scored higher in both the Improvement Activities and the Advancing Care Information categories, the Quality category carries the most weight so this brought your score back down. What happens next is your CPS is compared to everyone else’s CPS and based on where you rank, your positive payment adjustment and potential bonus payment is figured out. 

Hopefully, this series has helped you better understand the MIPS payment track of the Quality Payment Program. Come back next week for the beginning of the APMs payment track.  

Comments are closed.