What Are Benchmarks
Quality benchmarks are the standards used to rate the quality measures submitted by providers. When providers submit measures for the MIPS quality performance category, each measure is compared to its benchmark to figure out how many points it gets. Quality benchmarks are established for each type of data collection: QCDR measures, MIPS CQMs, eCQMs, CMS Web Interface measures, CAHPS for MIPS Survey measures, and Medicare Part B claims measures.
How Are Benchmarks Set Up
Quality benchmarks for the current performance period are based on performance data submitted to the Quality Payment Program (QPP) from previous performance periods, minus data submitted for suppressed measures.
When Are Measures Scored Against a Benchmark
Measures are scored against a benchmark if all of the below are true:
- The measure is complete (75% required for the 2024 performance period)
- It has enough cases (usually 20)
- There's a benchmark for the collection type
What If a Measure Isn't Complete
Incomplete measures can't be scored against a benchmark, and will receive 0 points. However, if an incomplete measure is submitted by a small practice, they can still earn 3 points.
What If a Measure Doesn't Have Enough Cases
Measures with not enough cases can't be scored against a benchmark, and will receive 0 points. However, if the measure is submitted by a small practice, they can still earn 3 points. Also, if the measure is new and if it’s complete, it'll get 7 points in the first year and 5 in the second. Note: this doesn't apply to administrative measures.
What If There's No Historical Benchmark
If there's no historical benchmark, an attempt will be made to calculate one using the data submitted for the current performance period. This includes data submitted by individual doctors, groups, and virtual groups eligible for MIPS within the same performance period, as well as those who chose to participate in MIPS. Note: there must be at least 20 instances of the measure, they all must be complete, have enough cases, and have a performance rate above 0% (or below 100% for inverse measures). Voluntary submissions will not be used.
If there's no historical benchmark and one cannot be calculated, the measure will receive 0 points. However, if the measure is submitted by a small practice, they can still earn 3 points. Also, if the measure is new and if it’s complete, it'll get 7 points in the first year and 5 in the second. Note: this doesn't apply to administrative measures.
For more detailed information regarding use of quality benchmarks within the Quality Payment Program, please visit the Benchmarks section of the QPP website: https://qpp.cms.gov/benchmarks
Or feel free to review the MIPS 2024 Quality Benchmarks User Guide below:
MIPS 2024 Quality Benchmarks User Guide