Each performance category is weighted across the four performance categories, which are adjusted over the first three years of the program as follows:
||2019 and beyond
|Advanced Care Information
(42 C.F.R. §§414.1330, 414.1350, 414.1355, 414.1375, 414.1380.) Note that these are default weights, and CMS can adjust it in certain circumstances.
For the 2017 transition reporting period, Quality makes up 60 percent, Advancing Care Information makes up 25 percent, Improvement Activities makes up 15 percent, while Cost is not to be factored into the composite score that determines the payment adjustment in 2019.
For the 2018 reporting period, Quality will make up 50 percent, Advancing Care Information will make up 25 percent, Improvement Activities make up 15 percent, and Cost will make up 10 percent of the composite score that will determine the payment adjustment in 2020.
Measures and activities are scored as follows in the four performance categories:
- Quality. Scored between 1 and 10 points and measured against benchmarks. Bonus points are available for submitting specific types of measures and submitting measures using end-to-end electronic reporting. Beginning in the 2018 performance reporting year, improvement scoring is available.
- Cost. Scored between 1 and 10 points and measured against benchmarks. Beginning in the 2018 performance reporting year, improvement scoring is available.
- Improvement Activities. Each improvement activity is worth a certain number of points which are summed and scored against the total maximum score of 40 points.
- Advancing Care Information. Sum of the base score, performance score, and bonus score. See Question 10.
In addition, MIPS eligible clinicians, groups, virtual groups, or APM entities that submit data on at least 1 performance category during the 2018 performance period can earn up to 5 bonus points for the treatment of complex patients or 5 bonus points for practicing in a small practice (defined as 15 or fewer eligible clinicians). (42 C.F.R. §414.1380.)
The final composite score of 0 to 100 points for a performance period for MIPS payment year is determined by the sum of each performance category score multiplied by the performance category weight plus the any applicable bonus points for small practices and the treatment of complex patients. (Id.)