Quality ID
|
Measure
|
High Priority* Measure?
|
Measure Specifications
|
102
|
Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
|
Yes
|
Registry
QOPI QCDR
EHR
|
143
|
Pain Intensity Quantified
|
Yes
|
Registry
QOPI QCDR
EHR
|
144
|
Plan of Care for Pain
|
Yes
|
Registry
|
156
|
Radiation Dose Limits to Normal Tissues
|
Yes
|
Registry
Claims
|
*High priority measures are those categorized as outcome, appropriate use, patient safety, efficiency, patient experience, and care coordination.
Aside from the specialty measure set, there are other MIPS quality measures that could potentially be reported by a radiation oncology practice, shown in this curated list.
Overview
The following equation can be utilized to calculate the quality score:
Quality Score =
Measure Points + Bonus PointsTotal Available Measure Points
The details of the measure points, bonus points, and total possible points are described below. The Quality score cannot exceed 100 percent.
The following equation can be utilized to calculate the quality category points awarded towards the composite performance score (CPS):
Quality Points towards CPS = (Quality Score + Improvement Score) x (Category Weight)
The improvement score is discussed in detail below. The category weight of the performance category can vary from 50 percent to 85 percent depending on whether the physician is exempt from Promoting Interoperability (PI) and/or whether cost measure can be calculated for the physician.
Measure Points
Each measure will receive a total score from 0 to 10 points based on reporting and performance.
- 0 points will be awarded if no data is submitted.
- 1 baseline “reporting” point will automatically be awarded if any data is submitted for a large practice.
- 2 to 9 additional achievement points will be added to the 1 baseline point based on a practice’s performance against a benchmark, but only if the data completeness requirements are met.
As a reminder, practices must submit data on 60 percent of all patients (regardless of payer) that meet the measure’s denominator criteria for a full year. The only exception to this requirement is for measures reported via claims, in which case, groups must submit data on 60 percent of all Medicare Part B patients that meet the measure’s denominator during the reporting period.
To earn achievement points, practices need to submit a minimum of 20 cases per measure and a measure benchmark must exist. If a benchmark was not available from historical data, CMS will attempt to calculate benchmarks based on 2018 performance data.
If a practice submits less than 20 cases for a measure or a measure does not have a benchmark, only 2 achievement points will be awarded and the practice will only receive the three baseline points for that measure.
Review the 2018 Radiation Oncology Measures Set Benchmarks.
For more information about benchmarks, review CMS's Benchmark Overview.
Bonus Points
There are two ways to receive bonus points in the Quality category. Bonus points will be added to a clinician’s overall Quality performance category points.
- End-to-end reporting - One bonus point if quality data is reported directly from an EHR to a qualified registry, QCDR, or via the CMS Web Interface.
- Additional measures –
- One bonus point for each additional high priority measure.
- Two bonus points for each additional outcome and patient experience measure.
Total Available Measure Points
The total available measure points will be 40 or 60 depending on whether you report the 4 measures in the radiation oncology measure set or 6 independent quality measures.
Improvement Score
Starting in 2018, CMS finalized the addition of an “improvement score” in the Quality performance category based on the previous MIPS performance period. To allow flexibility for practices to choose different measures from year to year, the improvement score will be based on the overall quality score instead of the performance on specific measures.
The improvement score can only be awarded if a practice has participated in the program for two consecutive years. However, CMS has made some accommodations to account for the Pick Your Pace transition options in 2017. If a practice has a previous year Quality score less than or equal to 30 percent, CMS will compare 2018 performance to an assumed 2017 Quality performance category score of 30 percent. This modification allows practices that chose the test pace in 2017 to still be eligible for the improvement score in 2018.
Improvement Score =
(2018 Quality Score - 2017 Quality Score)2017 Quality Score
x 10
For example, if a physician achieved a Quality performance score of 31 in the 2017 performance year and a Quality score of 37 in the 2018 performance year, the following equation would be utilized to calculate the improvement score:
Improvement Score =
(37 – 31)31
x 10 = 1.9 Improvement Score
The improvement score cannot be negative, meaning that a practice that did not have an increase in performance would receive zero improvement points.
Once the improvement score is calculated, the Quality performance category score is determined using the following equation:
([total measure achievement points + measure bonus points]/total available measure achievement points) + improvement score, not to exceed 100 percent.
The available measure achievement points will be 40 or 60 depending on whether you report the 4 measures in the radiation oncology measure set or 6 independent quality measures. The weight of the category, 50 percent, is then applied at the end of the calculation.
Using the same example as before, the Quality performance category score would be:
([37+0]/60)*100 = 61.6
61.6 + 1.9 = 63.5