Updates to the Quality Performance Score of the MIPS Performance Categories

Part of the Proposed CMS Rule for 2018

Centers for Medicare and Medicaid recognizes that the impending changes brought about by their new MACRA legislation place a burden on medical practices around the nation.  Now that MACRA has created the framework for the new healthcare programs, CMS has published a new ruling to update the methods and requirement for participating in these programs with the expressed aim of reducing the burden on individual healthcare providers and practices.

One of these updates is the 2018 Payment Program proposed ruling which was created to ease the burden of reporting, but also to increase the meaningfulness of compliance.  In other words, CMS aims to make collecting and submitting the necessary information faster and easier, while also providing these practices and healthcare providers with information that can help them improve patient care – both decreasing the cost of care and increasing the quality of that very same care.


Quality Performance Score

A practice’s or provider’s overall MIPS score is determined by a total of four categories, with the Quality Performance Category score weighted to comprise 60% of this overall total score.  That makes this one category pretty important for these first two full years of mandatory performance (2018 and 2019).  These first two years of this score being a full 60% of the overall score is to bring about a drastic change in the cost and quality of care, and effectively change the system from encouraging a larger quantity of patients being seen, to a greater quality of care provided.  After these these years, in 2020 this category will only comprise 30% of the overall MIPS score.

CMS has also stated that they aim to identify six measures in 2018 and again in 2019, that they will consider to be “topped out”.  This means that in each of these years, these six performance metrics will be considered to have very high performance rates.  This is a way of raising the standards of care provided.  Moving forward, in 2020, each of these metrics will be awarded a total number of 6 points, rather than 10. CMS believes that this change will inspire healthcare providers to seek out new ways of improving care for Medicare patients, and by sharing the information, this exploration will uplift all of healthcare.


For more information on how the Quality Performance Score is calculated, or how it will impact your practice, contact the experts at Main Street Medical