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2017 Quality Scoring and Benchmarking 1®

2017 Quality Scoring and Benchmarking

In this document:• Reporting Requirements, 1

• Reporting Methods, 1

• Scoring, 3

• Benchmarks, 4

The Quality performance category replaces the Physician Quality Reporting System (PQRS) and the Clinical Quality Measure (CQM) component of meaningful use. Familiarity with these previous quality programs will help you choose measures that are appropriate for your practice.

This document explains which measures are available, which submission options are available, and how those different submission methods are scored for each measure.

Reporting Requirements

To qualify for an incentive payment in 2017, you must report six measures, one of which must be an outcome measure. Quality accounts for 60% of your MIPS score.

CMS understands that the transition from legacy incentive programs like meaningful use and PQRS to MIPS will be a burden to many clinicians. To alleviate some of the anxiety, CMS is allowing you to "pick your pace" in 2017. This flexibility allows you to report one quality measure to avoid a payment penalty in 2019. Under the “submit something” option, measure benchmarking does not apply.

Reporting Methods

ExamWRITER supports three reporting methods, or submission mechanisms:

• Claims

• EHR

• AOA MORE

NOTES • In general, claims-based submissions score the lowest and EHR submissions score the highest.

• Attempt as many measures as you can. Periodically run the MIPS Quality calculator to check your progress. Use the MIPS Quality calculator to decide which measures to report and which reporting method to use.

2 2017 Quality Scoring and Benchmarking

2017 Quality Scoring and BenchmarkingReporting Methods

In 2017, you must choose one reporting method for all of your quality measures. You cannot mix reporting methods (e.g., use claims-based reporting for some measures and registry reporting for others). If you submit measures using multiple methods, CMS will give you credit only for your highest-scoring reporting method.

Not every reporting method is available for each measure; therefore, you’ll need to choose your reporting method based on measures in which you score highest. The following table lists each of the measures supported by ExamWRITER and which reporting methods are available for each.

QualityNo. Measure Category High Priority Claims EHR AOA

MORE

Choose 1 Outcome measure

Choose 1 high priority if no Outcome is available

Choose 6 measures from one of these columns

1 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Intermediate Outcome

Yes ✓ ✓

12 Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Process ✓ ✓ ✓

14 Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Process ✓

18 Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy

Process ✓ ✓

19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

Process Yes ✓ ✓

117 Diabetes: Eye Exam Process ✓ ✓

128 Preventive Care and Screening: Body Mass Index (BMI)

Process ✓

130 Documentation of Current Medications in the Medical Record

Process Yes ✓ ✓ ✓

140 Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement

Process ✓

141 Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% or Documentation of a Plan of Care

Outcome Yes ✓

226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Screening and Cessation Intervention

Process ✓ ✓

236 Controlling High Blood Pressure Intermediate Outcome

Yes ✓ ✓ ✓

317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Process ✓ ✓

374 Closing the Referral Loop: Receipt of Specialist Report

Process Yes ✓

2017 Quality Scoring and Benchmarking 3

2017 Quality Scoring and BenchmarkingScoring

Scoring This section explains how to calculate your MIPS Quality score.

• Calculating Individual Measure Scores, 3

• Reporting Sufficient Data, 3

• Earning Bonus Points, 3

• Calculating Your Quality Score, 4

Calculating Individual Measure Scores

When you submit measures for the Quality category, your percentage performance is assessed against benchmarks to determine how many points you earn for each measure. You can receive anywhere from 3 to 10 points for each measure, not including bonus points. Benchmarks are specific to the submission method: claims, EHR, registry.

Each measure’s benchmarks are represented in terms of deciles. Points are awarded within each decile. If your percentage performance falls within the first or second decile, you’ll receive 3 points. If you’re in the 3rd decile you’ll receive somewhere between 3 and 3.9 points depending on your exact position in the decile. Higher deciles earn a corresponding number of points, as shown in the table below.

Reporting Sufficient Data

You must report a minimum of 20 cases for each measure to qualify for higher scores. Measures for which you report fewer than 20 cases will receive the minimum score of 3 points. The longer you participate, the easier it will be for you to meet the minimum case requirements.

Earning Bonus Points

You must report one outcome (or intermediate outcome) measure. If no outcome measures are available, you may report one high-priority measure.

Decile Points

Below 3rd 3.0

3rd 3.0–3.9

4th 4.0–4.9

5th 5.0–5.9

6th 6.0–6.9

7th 7.0–7.9

8th 8.0–8.9

9th 9.0–9.9

10th 10.0


2017 Quality Scoring and BenchmarkingBenchmarks

You can earn two bonus points for each additional outcome measure and one bonus point for each additional high-priority measure you report.

Although bonus points are available, scores in the Quality category are capped at 100%. In other words, the bonus points can help make up for deficiencies within the Quality category but cannot carried over to make up for deficiencies in other categories.

Calculating Your Quality Score

Quality is worth 60% of your total MIPS score. Your Quality performance is calculated using the following formula.

Since Quality is capped at 60 points and it reflects 60% of your overall MIPS score, it seems unnecessary to divide your raw score by 60 to find out your percentage. In future MIPS performance years, when Quality is no longer worth 60% of your MIPS score, it will become necessary to calculate the percentage.

Benchmarks CMS establishes the benchmarks for each measure and reporting method. Higher benchmarks reflect higher reporting in prior performance years. The 2017 benchmarks are based on actual performance data submitted to PQRS in 2015.

This section lists the benchmarking criteria for each measure supported by ExamWRITER. Benchmarks are displayed as both charts and tables:

• The charts give you a visual representation and help you quickly compare benchmarks across different reporting methods.

• The tables list the specific benchmark criteria for each reporting method.

Quality Score (%)

Points earned on requir --- Any bonus points+

Any points over 60–

60 points possible------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 100=

Points earned on required6 Quality measures



001: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

This is an inverse measure. A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Reporting that numerator option will produce a performance rate that trends closer to 0%, as quality increases.

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 35.00–25.72

25.71–20.32

20.31–16.23

16.22–13.05

13.04–10.01

10.00–7.42

7.41–4.01

≤ 4.00

EHR 54.67–35.91

35.90–25.63

25.62–19.34

19.33–14.15

14.14–9.10

9.09–3.34

3.33–0.01

0

EHRClaims

0%

20%

40%

60%

80%

100%

10th

Decile9th

Decile8th

Decile7th

Decile6th

Decile5th

Decile4th

Decile3rd

Decile



012: Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 99.01–99.99

— — — — — — 100

EHR 73.33–82.41

82.42–87.39

87.40–90.90

90.91–94.16

94.17–96.57

96.58–98.25

98.26–99.57

≥ 99.58

AOA MORE 95.07–98.10

98.11–99.35

99.36–99.99

— — — — 100

AOA MOREEHRClaims



014: Age-Related Macular Degeneration (AMD): Dilated Macular Examination

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims — — — — — — — 100

Claims



018: Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinop-athy

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

EHR 31.69–41.32

41.33–49.99

50.00–56.97

56.98–64.17

64.18–70.58

70.59–76.97

76.98–85.15

≥ 85.16

AOA MORE 31.69–41.32

41.33–49.99

50.00–56.97

56.98–64.17

64.18–70.58

70.59–76.97

76.98–85.15

≥ 85.16

AOA MOREEHR



019: Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims — — — — — — — 100

EHR 20.00–29.78

29.79–38.35

38.36–45.70

45.71–52.53

52.54–60.79

60.80–68.80

68.81–79.30

≥ 79.31

EHRClaims

0%

20%

40%

60%

80%

100%

10th

Decile9th

Decile8th

Decile7th

Decile6th

Decile5th

Decile4th

Decile3rd

Decile



117: Diabetes: Eye Exam

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 86.36–97.77

97.78–99.99

— — — — — 100

EHR 50.57–80.68

80.69–90.05

90.06–94.11

94.12–96.66

96.67–98.57

98.58–99.99

— 100

EHRClaims

0%

20%

40%

60%

80%

100%

10th

Decile9th

Decile8th

Decile7th

Decile6th

Decile5th

Decile4th

Decile3rd

Decile



128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

EHR 39.80–45.63

45.64–50.91

50.92–56.68

56.69–64.88

64.89–75.81

75.82–87.12

87.13–97.33

≥ 97.34

EHR



130: Documentation of Current Medications in the Medical Record

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 96.11–98.73

98.74–99.64

99.65–99.99

— — — — 100

EHR 76.59–87.88

87.89–92.73

92.74–95.35

95.36–97.08

97.09–98.27

98.28–99.12

99.13–99.75

≥ 99.76

AOA MORE 61.27–82.11

82.12–91.71

91.72–96.86

96.87–99.30

99.31–99.99

— — 100

AOA MOREEHRClaims



140: Age-Related Macular Degeneration (AMD): Counseling on Antioxidant Supplement

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 97.50–99.99

— — — — — — 100

Claims



141: Primary Open-Angle Glaucoma (POAG): Reduction of Intraocular Pressure (IOP) by 15% or Documentation of a Plan of Care

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims — — — — — — — 100

Claims



226: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 95.60–97.85

97.86–99.25

99.26–99.99

— — — — 100

EHR 72.59–81.59

81.60–86.68

86.69–90.15

90.16–92.64

92.65–94.67

94.68–96.58

96.59–98.51

≥ 98.52

EHRClaims

0%

20%

40%

60%

80%

100%

10th

Decile9th

Decile8th

Decile7th

Decile6th

Decile5th

Decile4th

Decile3rd

Decile



236: Controlling High Blood Pressure

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 57.69–63.44

63.45–68.28

68.29–72.78

72.79–77.06

77.07–81.47

81.48–86.75

86.76–93.42

≥ 93.43

EHR 50.00–55.39

55.40–59.72

59.73–63.59

63.60–67.38

67.39–71.00

71.01–75.33

75.34–80.89

≥ 80.90

AOA MORE 51.00–58.20

58.21–63.56

63.57–68.27

68.28–72.40

72.41–76.69

76.70–82.75

82.76–91.06

≥ 91.07

AOA MOREEHRClaims



317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

Claims 42.13–50.44

50.45–59.06

59.07–68.11

68.12–78.63

78.64–92.67

92.68–99.53

99.54–99.99

100

EHR 17.90–22.55

22.56–25.80

25.81–28.83

28.84–31.69

31.70–34.67

34.68–38.96

38.97–46.26

≥ 46.27

EHRClaims



374: Closing the Referral Loop: Receipt of Specialist Report

Submission Method

3rd Decile

4th Decile

5th Decile

6th Decile

7th Decile

8th Decile

9th Decile

10th Decile

EHR 2.70–6.24

6.25–11.46

11.47–18.15

18.16–25.57

25.58–36.95

36.96–51.17

51.18–71.87

≥ 71.88

EHR

0%

20%

40%

60%

80%

100%

10th

Decile9th

Decile8th

Decile7th

Decile6th

Decile5th

Decile4th

Decile3rd

Decile

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