Quality Bonus Score: Does minimum 20 encounters required for eligibility?

[Brijesh Shah]

Hi

Does minimum 20 encounters are required for high priority bonus score?

On Score preview, For Measure#374 (when IPP < 20)

{

                    "measureId": "374",

                        "value": {

                                 "isEndToEndReported": true,

                                     "performanceMet": 10,

                                  "performanceNotMet": 7,

                        "eligiblePopulationExclusion": 0,

                        "eligiblePopulationException": 0,

                                 "eligiblePopulation": 17

                    }

                }

Response: 

{
  "name": "374",
  "value": 0,
  "detail": "",
  "instrumentations": [
    "QUALITY-009",
    "QUALITY-053",
    "QUALITY-085",
    "QUALITY-096",
    "QUALITY-119"
  ],
  "metadata": {
    "performanceRate": 58.8235,
    "reportingRate": 100,
    "measureClass": "Class 2",
    "measureTitle": "Closing the Referral Loop: Receipt of Specialist Report",
    "highPriorityBonusEligible": false,
    "endToEndBonusEligible": true,
    "endToEndBonus": 1,
    "outcomeOrPatientExperienceBonus": 0,
    "highPriorityBonus": 0,
    "decileScore": 3,
    "performanceDenominator": 17,
    "performanceNumerator": 10,
    "eligiblePopulation": 17,
    "partialDecileScore": 0,
    "partialPoints": 0,
    "decile": -1,
    "deciles": null,
    "totalMeasurementPoints": 0,
    "totalBonusPoints": 0,
    "messages": {
      "measurementClass": "Eligible population is less than 20, reporting rate is greater than 60%",
      "decileScore": "Applied maximum points for Class 2 measure for small practice providers",
      "e2eBonusScore": "Bonus from isEndToEndReported",
      "totalMeasurementPoints": "No measurement points for processingStatus: undefined"
    },
    "noBenchmarks": false,
    "benchmarkType": "electronicHealthRecord",
    "eMeasureId": "CMS50v7",
    "cpcPlusGroup": "Other_Measure",
    "toppedOut": false,
    "isGhost": false,
    "submissionMethod": "electronicHealthRecord",
    "performanceStart": "2019-01-01",
    "performanceEnd": "2019-12-31",
    "isCpcPlus": false,
    "calculatedScore": 8.882100000000001
  }
}

On Score preview, For Measure#374 (when IPP > 20)

{

                    "measureId": "374",

                        "value": {

                                 "isEndToEndReported": true,

                                     "performanceMet": 20,

                                  "performanceNotMet": 7,

                        "eligiblePopulationExclusion": 0,

                        "eligiblePopulationException": 0,

                                 "eligiblePopulation": 27

                    }

                }

Response:

{
                    "name": "374",
                    "value": 10.9742,
                    "detail": "Contributing 10.9742",
                    "instrumentations": [
                      "QUALITY-143",
                      "QUALITY-009",
                      "QUALITY-051",
                      "QUALITY-078",
                      "QUALITY-091",
                      "QUALITY-096",
                      "QUALITY-105",
                      "QUALITY-110",
                      "QUALITY-111",
                      "QUALITY-113",
                      "QUALITY-117"
                    ],
                    "metadata": {
                      "performanceRate": 74.0741,
                      "reportingRate": 100,
                      "measureClass": "Class 1",
                      "measureTitle": "Closing the Referral Loop: Receipt of Specialist Report",
                      "highPriorityBonusEligible": true,
                      "endToEndBonusEligible": true,
                      "endToEndBonus": 1,
                      "outcomeOrPatientExperienceBonus": 0,
                      "highPriorityBonus": 1,
                      "decileScore": 8.9742,
                      "performanceDenominator": 27,
                      "performanceNumerator": 20,
                      "eligiblePopulation": 27,
                      "partialDecileScore": 0.9742,
                      "partialPoints": 13.8241,
                      "decile": 8,
                      "deciles": [
                        0,
                        7.63,
                        14.98,
                        26.33,
                        36.74,
                        48.15,
                        60.25,
                        74.44,
                        90.75
                      ],
                      "processingStatus": "PICKED",
                      "totalMeasurementPoints": 10.9742,
                      "totalBonusPoints": 2,
                      "messages": {
                        "measurementClass": "Eligible population is greater than or equal to 20, reporting rate is greater than 60% and has benchmarks",
                        "e2eBonusScore": "Bonus from isEndToEndReported",
                        "highPriorityBonus": "Allotting 1 point to high priority bonus for measure type 'process'",
                        "measurementPicker": "Picked at 2",
                        "totalMeasurementPoints": "Measurement points for PICKED measure include decile score with all bonus points"
                      },
                      "noBenchmarks": false,
                      "benchmarkType": "electronicHealthRecord",
                      "eMeasureId": "CMS50v7",
                      "cpcPlusGroup": "Other_Measure",
                      "toppedOut": false,
                      "isGhost": false,
                      "submissionMethod": "electronicHealthRecord",
                      "performanceStart": "2019-01-01",
                      "performanceEnd": "2019-12-31",
                      "isCpcPlus": false,
                      "unroundedScoreValue": 10.9742
                    }
                  }

I think for High priority bonus score, minimum 20 encounters criteria is not there. Can you please check and confirm?

[Steven Szeliga]

Good Morning,

Yes, the minimum encounters or eligible population is based off the eligiblePopulation field, where the value must be >= 20. Additionally a minimum of 60% reportingRate must be met in order to receive the high priority bonus. Please let me know if I can provide any additional information.

[QCDR Developer]

Hi Steven, when you say “60% reporting rate” do you mean the EC must report a minimum of 60% of eligible cases? Just confirming that there isn’t a minimum performance rate required for this bonus (since performance rate benchmarks vary across measures).

Thank you!

[John Wu]

Hi Steven - to clarify, if the eligible population is less than 20, but the reportingRate is above 60%, is the measure eligible for the high priority bonus?

[Brijesh Shah]

Hi Steaven,

Thanks for reply. In previous reporting years, for high priority bonus, 60% reporting rate was required only. Measures can get high priority and outcome bonus even minimum 20 encounters weren't submitted. 

Moreover, I am not able to find any document which specify minimum 20 encounters submission to get high priority and outcome bonus. 

Please review attachment.


 

[Steven Szeliga]

Good Morning,

It has always been meeting the minimum of 20 eligible population and minimum reporting rate of 60% for this year. Please see the attached image. Let me know if I can provide any additional information. 

[Brijesh Shah]

Hi Steven,

Thanks for clarification.