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In the last post in our MACRA 101 Series, we discussed picking your pace and featured an easy to follow infographic that outlined your options. In this post, we’ll talk a little about how you can improve your payment adjustment in 90 days.

MACRA & MIPS brings new Performance Categories for reporting on quality of care in 2017, and beyond.  You love your work as a Medical Professional.  You are passionate about the work you do, and the patients you serve.  You know you provide quality care – Now take a look at how you’ll report, and get paid, on that high-quality care.

Within MACRA there are two tracks: MIPS & Advanced APMs. The one we have been talking about in recent posts has been MIPS – the Merit-based Incentive Payment System. We looked at who is eligible, and the high-level timeline.  Now we are going to touch on what is to be reported, focusing on the Quality and Cost categories.

MIPS is a combination of the legacy PQRS, VM & EHR programs.  2016 was the last performance period for PQRS, and the last related payment will be in 2018.  MIPS has already officially begun.  2017 is the performance year for 2019 payment adjustments.  You’ll submit your reporting data by March 31, 2018.

Performance Categories

The Merit-based Incentive Payment System has four Performance Categories.  Each of the categories has been assigned a ‘weight.’  The weight refers to the value each has in your overall score.  The total score is based on a max of 100 points.  Here is how they break down:

  • Quality – 60%
  • Cost – 0%
  • Improvement Activities – 15%
  • Advancing Care Information – 25%

Keep in mind that these are the default weights.  Depending on circumstances, they could be adjusted.

The goals of these categories are:

  • Move Medicare Part B clinicians to a performance-based payment system
  • Provide clinicians with flexibility to choose the activities and measures that are most meaningful to their practice, and
  • Work to align reporting standards with Advanced APMs as much as possible.


Let’s look at the first two categories:


The Quality category, which is worth 60% of your total score, replaces PQRS and the Quality Portion of the Value Modifier.  This provides an easier transition, especially since most providers are familiar with the measures.

You must select six quality measures to report – the good news is you have 300 to choose from.  One of the six measures must be an outcome measure or a high priority measure.  The high priority measure could be:

  • An outcome,
  • Appropriate use,
  • Patient experience,
  • Patient safety,
  • Efficiency or
  • Care coordination.

Reporting must be for a minimum of 90 days to be eligible for a maximum payment adjustment.  There are different requirements for groups reporting via the CMS Web Interface, or those in MIPS APMs.  You may also select specialty-specific measures.

Your total performance category score is based on the points you earn on your required six quality measures, plus any bonus points.  That amount of points will be divided by the maximum number of points.  Your maximum score will not exceed 100%.  Clinicians receive 3-10 points on each quality measure – based on performance against benchmarks.  If you don’t submit performance data, you are scored 0 points.  There are bonus points available.



2017 does not have a Cost reporting requirement.  This may change in future performance years.  Clinicians are assessed on Medicare claims data.  CMS will still provide you feedback on how you performed in 2017, but it will not affect your 2019 payment.  It still uses measures that were used in the Physician Value-based Modifier program, or in the Quality and Resource Use Report (QRUR).  Only the scoring is different.  Clinicians earn a maximum of 10 points per episode cost measure.

Quality and Cost are only the first two Performance Categories.

Make sure to subscribe, so you don’t miss future updates to this series. Check out the Quality Payment Program – Executive Summary for all of the details. Don’t miss the next post where we’ll look at the final two Performance Categories: Improvement Activities and Advancing Care Information.

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