MIPS: Navigating The Quality Category


Quality Program Specialist

Welcome back to our blog series, MIPS: A Closer Look! This series is part of TSI Healthcare’s ongoing commitment to helping you navigate the murky waters of the Merit-based Incentive Payment System (MIPS). This week we’re taking a closer look at the Quality category.

Before you begin reading, make sure you’re up to date on the other blogs in our series.

  1. MIPS: Navigating The Advancing Care Information Category
  2. MIPS: Navigating The Improvement Activities Category


The Quality category, formerly known as the Physician Quality Reporting Program, directly mirrors PQRS and CQM by using these programs’ existing quality measures. In 2017, the Quality category will account for 60% of your overall MIPS composite score. The focus will be on clinical quality, which measures the quality of care providers deliver to their patients.



Since 2017 is a MIPS transition year, the Quality category will account for 60% of your overall MIPS composite score. However, this category’s overall weight will decrease to 50% in 2018 as the Cost category increases from 0% to 10%. Based on the six Quality measures an Eligible Clinician (EC) can choose to report on, an EC may receive up to 60 points for this category. Each of these measures are worth 3-10 points depending on how well the EC performs based on the benchmark set by CMS. These benchmarks will be based on past PQRS and CQM data.

Note, groups of 16 ECs or larger will be scored on an additional measure which means they are eligible to receive 70 points for this category.

Click here to learn more about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Category Details
See below for a comparison of the former PQRS and CQM programs and the new Quality category.

 Previous Programs  2017 Quality Programs
PQRS & CQM – Practitioners were required to report on 9 measures across 3 domains. Practitioners are now required to report on 6 measures with no domain requirements.
PQRS & CQM – Previously, there was no emphasis on outcome reporting measures. Emphasis will now be on reporting outcomes measures.
PQRS – Practitioners were previously required to report on one cross-cutting measure. Cross-Cutting measures are no longer required.
PQRS – Data completeness: 50% of patients across Medicare Part B patients. Data completeness:  50% of patients across all payers.


Types of Quality Measures 
Clinical Quality Measures (CQMs) & Physician Quality Reporting System (PQRS) measures are recorded through EHR workflows and reflect the clinical quality of care at a practice. It is in the practice’s best interest to report on measures that reflect positively on the quality of care provided to your patients as measures reported may become public data. Many CQM measures have overlapping workflows and track similar outcomes as PQRS measures. Some CQM and PQRS measures have identical workflows while others do not. The Quality category of MIPS takes two previously separate quality reporting programs and combines them to allow ECs the opportunity to report on either CQM or PQRS measures to meet the six measure requirements.

Quality Program Services
Do you need more help navigating the Quality category? Schedule an appointment with your Client Solutions Advisor today to learn more about your practice’s options.

Need more help navigating MACRA? Watch our webinar “MACRA101: The New Quality Payment Program,”
to learn more about the new federal policy changes.

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