Scoring well in quality has just become more difficult.
Your quality score on each quality measure is based upon ‘Deciles’.
Think of it as being graded on the curve. If you score a 95 on a test you think you have a good grade, but if class average on that test was a 98 you will get a poor grade. Scoring for quality measures is similar to that type of grading.
For example Measure 047 : Advance Care Plan is scored in the following manner if you report through a registry
In this case a score of 95% is only worth approximately 7 points
For those reporting on claims the metrics are even worse
When reporting on claims a score of 95 is only worth 3 points
Notice that there is no way to get 9, 7, or 6 points miss even one patient, and you are at the 5th decile.
If you were already aware of the decile scoring and you looked at the data published by CMS earlier this year to select your measures, you are in for a bit of a surprise. On June 11, CMS sent out the following email:
“The Centers for Medicare & Medicaid Services (CMS) is committed to transparency, data integrity and open communication with our stakeholders. Through our ongoing quality assurance efforts, we identified and corrected an error with the decile outputs affecting the 2021 historical quality measure benchmarks file. This issue affected every measure in the benchmarks file. As a result of the correction, the range of performance rates for a given decile have shifted down one decile.
- The range of performance rates that were previously identified for Decile 5 (eligible for 5 – 5.9 points) now show correctly as the range of performance rates for Decile 4 (eligible for 4 – 4.9 points).
- The range of performance rates that were previously identified for Decile 8 (eligible for 8 – 8.9 points) now show correctly as the range of performance rates for Decile 7 (eligible for 7 – 7.9 points).”
This means what ever you though you would get for a particular measure may have decreased by 1 full decile. To achieve a perfect score in the quality portion of MIPS you need to earn a total of 60 points in quality. Earning 60 points has just gotten more difficult.
It is also important to remember that in 2021 you need to achieve a composite score of at least 60 points which is an increase from the 45 points needed to avoid a penalty last year.
With the year almost halfway gone, now is a good time to look at the measures you are reporting and see what your expected MIPS composite score would. You still have 6 months to work on improving your MIPS score for 2021.