| Measure ID |
Title |
Description |
Weight |
Subcategory ID |
|
IA_PCMH
|
Patient Centered Medical Home Attestation
|
I attest that I am a Patient Centered Medical Home (PCMH) or Comparable Specialty Practice that has achieved certification from a national program, regional or state program, private payer, or other body that administers patient-centered medical home accreditation and should receive full credit for the Improvement Activities performance category.
|
|
|
|
IA_AHE_1
|
Engagement of new Medicaid patients and follow-up
|
Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare.
|
High |
Achieving Health Equity |
|
IA_BE_6
|
Collection and follow-up on patient experience and satisfaction data on beneficiary engagement
|
Collection and follow-up on patient experience and satisfaction data on beneficiary engagement, including development of improvement plan.
|
High |
Beneficiary Engagement |
|
IA_BMH_6
|
Implementation of co-location PCP and MH services
|
Integration facilitation, and promotion of the colocation of mental health services in primary and/or non-primary clinical care settings.
|
High |
Behavioral And Mental Health |
|
IA_BMH_7
|
Implementation of integrated PCBH model
|
Offer integrated behavioral health services to support patients with behavioral health needs, dementia, and poorly controlled chronic conditions that could include one or more of the following:
Use evidence-based treatment protocols and treatment to goal where appropriate;
Use evidence-based screening and case finding strategies to identify individuals at risk and in need of services;
Ensure regular communication and coordinated workflows between eligible clinicians in primary care and behavioral health;
Conduct regular case reviews for at-risk or unstable patients and those who are not responding to treatment;
Use of a registry or certified health information technology functionality to support active care management and outreach to patients in treatment; and/or
Integrate behavioral health and medical care plans and facilitate integration through co-location of services when feasible.
|
High |
Behavioral And Mental Health |
|
IA_CC_4
|
TCPI participation
|
Participation in the CMS Transforming Clinical Practice Initiative.
|
High |
Care Coordination |
|
IA_EPA_1
|
Provide 24/7 access to eligible clinicians or groups who have real-time access to patient's medical record
|
Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following:
Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care);
Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or
Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management
|
High |
Expanded Practice Access |
|
IA_ERP_2
|
Participation in a 60-day or greater effort to support domestic or international humanitarian needs.
|
Participation in domestic or international humanitarian volunteer work. Activities that simply involve registration are not sufficient. MIPS eligible clinicians attest to domestic or international humanitarian volunteer work for a period of a continuous 60 days or greater.
|
High |
Emergency Response And Preparedness |
|
IA_PM_1
|
Participation in systematic anticoagulation program
|
Participation in a systematic anticoagulation program (coagulation clinic, patient self-reporting program, patient self-management program)for 60 percent of practice patients in year 1 and 75 percent of practice patients in year 2 who receive anti-coagulation medications (warfarin or other coagulation cascade inhibitors).
|
High |
Population Management |
|
IA_PM_2
|
Anticoagulant management improvements
|
MIPS eligible clinicians and groups who prescribe oral Vitamin K antagonist therapy (warfarin) must attest that, in the first performance year, 60 percent or more of their ambulatory care patients receiving warfarin are being managed by one or more of these clinical practice improvement activities:
Patients are being managed by an anticoagulant management service, that involves systematic and coordinated care*, incorporating comprehensive patient education, systematic INR testing, tracking, follow-up, and patient communication of results and dosing decisions;
Patients are being managed according to validated electronic decision support and clinical management tools that involve systematic and coordinated care, incorporating comprehensive patient education, systematic INR testing, tracking, follow-up, and patient communication of results and dosing decisions;
For rural or remote patients, patients are managed using remote monitoring or telehealth options that involve systematic and coordinated care, incorporating comprehensive patient education, systematic INR testing, tracking, follow-up, and patient communication of results and dosing decisions; and/or
For patients who demonstrate motivation, competency, and adherence, patients are managed using either a patient self-testing (PST) or patient-self-management (PSM) program.
The performance threshold will increase to 75 percent for the second performance year and onward.
Clinicians would attest that, 60 percent for first year, or 75 percent for the second year, of their ambulatory care patients receiving warfarin participated in an anticoagulation management program for at least 90 days during the performance period.
|
High |
Population Management |
|
IA_PM_3
|
RHC, IHS or FQHC quality improvement activities
|
Participating in a Rural Health Clinic (RHC), Indian Health Service (IHS), or Federally Qualified Health Center in ongoing engagement activities that contribute to more formal quality reporting, and that include receiving quality data back for broader quality improvement and benchmarking improvement which will ultimately benefit patients. Participation in Indian Health Service, as an improvement activity, requires MIPS eligible clinicians and groups to deliver care to federally recognized American Indian and Alaska Native populations in the U.S. and in the course of that care implement continuous clinical practice improvement including reporting data on quality of services being provided and receiving feedback to make improvements over time.
|
High |
Population Management |
|
IA_PM_4
|
Glycemic management services
|
For outpatient Medicare beneficiaries with diabetes and who are prescribed antidiabetic agents (e.g., insulin, sulfonylureas), MIPS eligible clinicians and groups must attest to having:
For the first performance year, at least 60 percent of medical records with documentation of an individualized glycemic treatment goal that:
a) Takes into account patient-specific factors, including, at least 1) age, 2) comorbidities, and 3) risk for hypoglycemia, and
b) Is reassessed at least annually.
The performance threshold will increase to 75 percent for the second performance year and onward.
Clinician would attest that, 60 percent for first year, or 75 percent for the second year, of their medical records that document individualized glycemic treatment represent patients who are being treated for at least 90 days during the performance period.
|
High |
Population Management |