Your MIPS Quality score
The Quality component of MIPS is calculated through PQRS Clinical Quality Measures. Each measure is calculated as a percentage of measure-specific criteria found here. For each measure, there is:
- A numerator component that describes patients that count toward improving your measure score
- The patient population representing the denominator
- Any exceptions that would exclude patients from falling under the calculation logic
Once the measure's percentage is calculated, the percentage will fall under a decile specified by CMS. What decile the percentage falls to indicates the number of points you will get toward your Quality score.
- A "Met Requirement" refers to the patient, medication, etc. fraction specific to each measure. To read more on the numerator and denominator of this fraction, please refer to our help center section found here.
- Measure Calculation = 26/100 = 26%
- 26% corresponds to decile 4 (24% - 36%) which awards a point spread of 4.0 - 4.9 points.
- 26% is 2% higher than the base percentage of this decile (24%). If your measure percentage was 24%, the number of points awarded for this measure would be 4.0.
- Since your score is 2% higher, you will be awarded a point value linearly proportional to the point range of the decile. Since this decile spans 12%, you will get 1%/12% = 0.16 points more than the base value, or 4.16 points toward your quality score.
- Since Quality is weighted at 60% of your total MIPS score, your final point contribution would be 4.16 * 60% = 2.5 points.
We've made point calculations easy for you to understand by giving you the percentages you need in our MACRA/MIPS dashboard.
For each Quality measure, once we've detected a valid initial population (ie. patients, faxes, messages), a 'Show Chart' button will appear. Click on this to see what fraction you'll need to hit in order to achieve a higher score. A line graph will show you what fraction corresponds to what score with an indicator for your current performance.
Improving Your Score
STEP 1: Pick a measure and identify what percentage you need to hit. You can do this in our MACRA/MIPS dashboard.
STEP 2: Check our Clinical Quality Measures dashboard to see the current numbers for your numerator/denominator.
STEP 3: Find the measure in our help center section and find out what specific actions/codes need to be done or added for a patient to be included in the numerator.
STEP 4: Make those changes and see your percentage and point score update.