One aspect that practices may face as they conduct their quality reporting under CMS’s Merit-based Incentive Payment System (MIPS) in 2018 are “topped-out measures.”
As you know, this year’s MIPS guidelines require practices to report on a number of categories in order to be evaluated and receive additional reimbursements under the Quality Payment Program (QPP). In MIPS, categories are weighted differently, with the Quality category accounting for 50 percent of the final score practices receive (the most-weighted category in the 2018 reporting period).
Practices will select six quality measures to report on from more than 200 available measures within the Quality category. “Topped-out measures” are specific quality measures in which—according to CMS—“meaningful distinctions and improvement in performance can no longer be made.” For example, a process measure (which make up half of all measures) would be topped-out if median performance is 95 percent or higher—or 5 percent or lower if it is scored inversely, both of which would be deemed too easily attainable.
Topped-out measures may make it difficult for practices to receive the maximum number of points under the QPP, but by identifying measures as topped-out, CMS is incentivizing practices to choose other measures where considerable performance improvement is more likely.
Looking ahead, CMS will continue to identify and top out measures that do not offer MIPS-eligible clinicians significant improvement opportunities. Once identified, measures will be phased out over a four-year timeline consisting of capping the measure to a lower maximum score, followed by the measure’s removal entirely.
However, some topped-out measures may remain in the program for longer than four years as CMS considers the maintenance of measures that contribute important aspects of patient safety and reliability.
What can practices do to prepare?
1. Compare the current 2018 MIPS Quality Benchmarks.
Current benchmarks can help determine if a quality measure is topped-out. An example of a commonly reported topped out measure is Documentation of Current Medications (Quality Measure ID 130), which is topped-out for all methods of reporting but does not yet have capped scoring. Variance in decile scoring is so limited that one performance mistake could lose you several points, depending on the method of reporting. If a practice is reporting this measure through a qualified registry or QCDR, they can only score 10 points if they score 100 percent, a perfect performance. Any score of 99.99 percent or less would drop the practice down to the 7th decile (worth 7.0-7.9 points). That leaves practices no leeway in workflow errors, as just one patient missed could keep them from maintaining perfect performance.
Review the full list of 2018 topped-out measures here.