2018 MIPS Quality Measure Benchmarks Overview
The majority of MIPS quality measures have been assigned benchmarks based on reported performance in prior years. The “raw” score obtained by the clinician or group is then compared to the benchmarks for that measure and this is used to determine the final score for the measure.
The benchmarks are arranged in deciles. They are specific to reporting mechanisms including the claims, registry (Qualified Registries and Qualified Clinical Data Registries) and EHR reporting mechanisms.
Benchmark values for the MIPS Quality Measures “Pneumococcal Vaccination Status for Older Adults” are shown in the table below. Note how a clinician or group reporting through the claims reporting mechanism would need to achieve a performance rate of at least 99.69 percent to achieve the highest possible score for this measure of 10 points. However, a group reporting through the EHR mechanism would only need to achieve a score of 85.17% or higher to earn the full 10 points for this measure.
|Pneumococcal Vaccination Status for Older Adults||111||Claims||Process||Y||26.2||68.3||44.78 - 55.87||55.88 - 65.57||65.58 - 73.27||73.28 - 80.67||80.68 - 87.34||87.35 - 93.84||93.85 - 99.68||>= 99.69||No||No||--||--|
|Pneumococcal Vaccination Status for Older Adults||111||EHR||Process||Y||28.9||46.3||15.40 - 25.61||25.62 - 37.30||37.31 - 47.48||47.49 - 56.46||56.47 - 65.52||65.53 - 75.08||75.09 - 85.70||>= 85.71||No||No||--||--|
|Pneumococcal Vaccination Status for Older Adults||111||Registry/QCDR||Process||Y||28.4||58||29.93 - 45.27||45.28 - 55.09||55.10 - 62.58||62.59 - 69.99||70.00 - 76.96||76.97 - 83.99||84.00 - 92.88||>= 92.89||No||No||--||--|
Many benchmarks are elevated and in some cases “topped out,” meaning that historical performance on the measures has been extremely high. CMS decided to label 6 measures as ‘topped out” for the 2018 reporting year.
High benchmarks make it difficult to attain high scores on many measures. For example, the registry benchmark values for the MIPS measure “Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention” are shown below. Note that a
“raw score” performance rate of 91.10% would yield a performance score of 4.9 points for this measure.
|Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention||226||Registry/QCDR||Process||Y||15.4||88.8||83.72 - 88.38||88.39 - 91.10||91.11 - 93.34||93.35 - 95.44||95.45 - 97.35||97.36 - 99.00||99.01 - 99.99||100.00||No||No||--||--|
Some benchmarks are “inverted,” meaning that low performance results in higher performance scores. An example of this is the Diabetes: HbA1c Poor Control Measure show below.
|Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)||1||Registry/QCDR||Outcome||Y||27.1||34.8||57.89 - 42.37||42.36 - 31.59||31.58 - 25.78||25.77 - 20.94||20.93 - 16.82||16.81 - 12.78||12.77 - 7.70||<= 7.69||No||No||--||--|
Some measures do not have benchmarks. These are generally the newer measures as CMS has not received adequate amounts of data to calculated benchmark values. If a practice reports a measure and CMS is unable to determine benchmark values for the measure the clinician or group will receive a score of 3 points on the measure, regardless of their actual performance. However, if the CMS is able to determine benchmark values, the benchmark values have the potential of not being as stringent as other more established measures. This could result in higher performance scores on these measures.
A number of measures are only available via Qualified Clinical Data Registries (QCDRs) and these may have been developed recently by specialty organizations, making them a better fit clinically for specialty practices. However, as they are relatively new they may not have current benchmarks. Choosing to report these measures as “additional measures” to your core measure set of six measures may be an option. Once benchmarks have been determined CMS will choose the 6 highest performing measures submitted by a practice to determine the quality performance category score.
The 2018 MIPS quality measure benchmarks are available here.