Decile Ranking
Decile ranking is the MIPS methodology that translates a clinician's quality measure performance rate into a point value (1–10) by comparing it to national benchmark percentile ranges — with the resulting points summed to calculate the MIPS Quality category score.
How Decile Ranking Works
In MIPS, the Quality category (weighted at 30% of the MIPS composite score) is determined by the performance of 6 or more reported quality measures. Each individual measure earns between 1 and 10 achievement points based on where the clinician's performance rate falls within the national benchmark decile distribution. The total Quality category score is the sum of points earned across all reported measures, divided by the maximum available points, scaled to 100%.
Decile Point Assignment
For each MIPS quality measure with a national benchmark, CMS divides the national performance rate distribution into 10 equal segments (deciles) based on the prior year's reporting data. Each segment corresponds to an achievement point value:
- Decile 1: Performance at or below the 10th percentile = 1 point
- Decile 2: 10th–20th percentile = 2 points
- Decile 3: 20th–30th percentile = 3 points
- Decile 4–9: Continue incrementally
- Decile 10: Performance at or above the 90th percentile = 10 points
A minimum floor of 3 points is awarded for measures where the clinician meets the case minimum threshold but has a zero performance rate (meaning the denominator is met but no numerator events are counted). This prevents absolute zero scoring on measures with small case counts.
Measure Selection Strategy
Because not all quality measures have the same benchmark distributions, strategic measure selection is critical for maximising MIPS Quality points. A measure where your practice already achieves the 9th decile (9 points) contributes more to your Quality category score than a measure where you're at the 4th decile (4 points), even if both involve similar clinical activities. Practitioners should select measures where their performance rates are highest relative to the national benchmark distribution — not simply measures that are clinically relevant or administratively convenient to report.
Bonus Points
High Priority measures (outcome, patient experience, opioid-related, and care coordination measures) earn a 2-point bonus on top of the decile points earned. Reporting additional measures beyond the required 6 can also earn bonus points. These bonuses can push the Quality category score above 100%, increasing the overall MIPS composite score toward the exceptional performance threshold.