The Quality category asks that clinicians report on 6 measures at least 70% of the time that they apply.
Each of those 6 measures counts anywhere from 1 to 10 points. A 3 point minimum score will be assigned to solo clinicians and groups of 15 or fewer for any measure that:
- does not satisfy the 70% reporting frequency requirement
- lacks 20 cases in the denominator
If each of the above is false, the actual performance on the measure will be considered by comparing the clinician’s score to a benchmark comprised all all-clinician performance two years earlier.
Ultimately, a clinician or small group’s Quality score is based on the sum of points for the 6 best scoring measures reported.
There are also opportunities to earn bonus points by submitting additional outcome (2 points each) or high priority measures (1 point each) and by submitting data via certified EHR technology (CEHRT) (1 point each). Importantly, to earn bonus points for additional outcome or high-priority measures, the measure needs to be reported successfully (i.e. ≥70% of applicable cases and have at least 20 cases in the denominator). Planning to include additional high priority measures and/or via CEHRT, then, is a way to plan for higher scoring. A full list of all available measures is available on the Quality Payment Program website.
Finally, on the scoring front, there is the opportunity for up to 10 bonus points based on improvement in the category from the previous year.