What is the Advancing Care Information (ACI) Performance Category for MIPS and how is it scored?

What is the Advancing Care Information (ACI) Performance Category?
Under the Merit-based Incentive Payment System (MIPS) pathway of the MACRA Quality Payment Program, ACI has replaced the Medicare EHR Incentive Program (Meaningful Use). In 2017, ACI is also one of the three performance categories that will be considered and weighted for scoring a clinician’s overall performance under MIPS. Please note that starting in 2018, four performance categories will be considered and weighted for scoring a clinician’s overall performance under MIPS.

Under MIPS, ACI scoring will be determined based on a clinician’s satisfaction of the four required ACI base score measures as well as their performance on additional ACI performance score and ACI bonus score measures.

For the MIPS 2017 performance year, Practice Fusion will support the 2017 ACI Transition Measure Set, which is available for eligible clinicians using 2014 Edition Certified EHR technology (CEHRT). For more information on the 2017 ACI Transition Measure Set, please click here.

Reporting requirements
Determine which participation method for MIPS you wish to use in 2017, and then complete the ACI reporting requirements associated with that participation method as outlined below.

  • MIPS Test Pace Participation. Submit data for the four required ACI base score measures from the 2017 ACI Transition Measure set. If you choose to report the ACI category for Test Pace participation, yes/no measures must be reported as a “yes” and any measure that has a numerator and denominator must have a numerator of at least 1 and a denominator of at least 1 in order to receive credit for this category.  

  • MIPS Partial Year Participation. Submit 90 days of 2017 data to Medicare for the four ACI Transition Measure Set required base score measures and at least one additional performance score measure from the 2017 ACI Transition Measure set by March 31, 2018. All reported ACI base score measures must have at least 1 in the denominator and 1 in the numerator and yes/no measures must be reported as a “yes” in order to receive credit for this category.

  • MIPS Full Year Participation. Submit a full year of 2017 data (January 1, 2017 through December 31, 2017) to Medicare for the four ACI Transition Measure Set base score measures and at least one additional performance score measure from the 2017 ACI Transition Measure set before March 31, 2018. All reported ACI base score measures must have at least 1 in the denominator and 1 in the numerator and yes/no measures must be reported as a “yes” in order to receive credit for this category.

ACI Category Scoring for 2017
The ACI category is worth 25% of a clinician’s MIPS Composite Performance Score (also called the MIPS final score) during the 2017 performance year and is scored based on satisfaction of base score, performance score and bonus score requirements. The ACI Performance Category has the potential for over 100% as a total score, but the contribution to the MIPS final score is capped at 100%. For example, under the current scoring methodology, it is possible to earn the maximum ACI performance category score without completing any bonus activities.

Base Score + Performance Score + Bonus Score = ACI Category Total Score

Base Score
To achieve the ACI base score, Practice Fusion providers who are MIPS eligible clinicians will need to satisfy the four required base score measures included in the 2017 ACI Transition Measure Set. In order to receive base score credit, all reported measures must have at least 1 in the denominator and 1 in the numerator and Yes/No measures must be reported as a “Yes”. Failure to meet the base score measure reporting requirements will result in a base score of zero. Furthermore, this will prevent the clinician from earning any additional performance score credit and will result in an ACI performance category score of zero.

The ACI base score accounts for 50% of a clinician’s total ACI performance category score. The required base score measures that are part of the 2017 ACI Transition Measure Set are as follows:

  • Security Risk Analysis: Conduct or review a security risk analysis in accordance with the requirements set forth in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by CEHRT in accordance with the requirements set forth in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), implement security updates as necessary, and correct identified security deficiencies as part of the MIPS eligible clinician’s risk management process. Learn more>>

  • Electronic Prescribing: At least one permissible prescription written by the MIPS eligible clinician must be queried for a drug formulary and transmitted electronically using CEHRT. Learn More>>

  • Provide Patient Access: At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician’s discretion to withhold certain information. Learn More>>

  • Health Information Exchange: The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits that summary to a receiving health care clinician for at least one transition of care or referral. Learn More>>

Performance Score
To achieve an ACI performance score in addition to the base score, a MIPS eligible clinician must satisfy at least one additional ACI performance score measure during his or her performance period. This means that at least one performance score measure must have a numerator greater than 1 and clinicians must submit a numerator/denominator or Yes/No for each ACI performance score measure they report.

The percentage listed next to each 2017 ACI Transition Measure Set measure below indicates how much that measure can contribute to the ACI performance score, based on the measure rate (which is the numerator divided by the denominator). The exception to this is the Immunization Registry Reporting measure, which is a Yes/No performance score measure and is not scored based on a measure rate. Performance score measures can be worth up to 90% of the total ACI score, giving clinicians the flexibility to focus on achieving the measures that are most meaningful to their practice. The higher a clinician’s performance rate on these measures, the higher their ACI score will be.

Performance Score measures in the 2017 ACI Transition Measure Set consist of the following:

  • Provide Patient Access (up to 20%): To earn performance score credit for this measure, the clinician may complete the base score numerator requirements as detailed above for as many additional denominator eligible patients as the clinician deems appropriate during their selected 2017 performance period. Learn More>>

  • View, Download, or Transmit (VDT) (up to 10%): At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period. Learn more>>

  • Health Information Exchange (up to 20%): To earn performance score credit for this measure, the clinician may complete the base score numerator requirements as detailed above for as many additional denominator eligible patients as the clinician deems appropriate during their selected 2017 performance period. Learn More>>

  • Secure Messaging (up to 10%): For at least one patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative), during the performance period. Learn More>>

  • Medication Reconciliation (up to 10%): The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. Learn More>>

  • Patient-Specific Education (up to 10%): The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. Learn More>>

  • Immunization Registry Reporting (0 or 10%, Yes/No measure): The MIPS eligible clinician is in active engagement with a public health agency to submit immunization data generated using CEHRT. Learn More>>

Performance score measures will earn points towards the MIPS eligible clinician’s total ACI score using a decile scoring methodology. The table below shows how a performance score measure’s performance rate is translated into points that contribute to the total score. The methodology listed below would be specific to a performance score measure that can contribute up to 10% of the total ACI score.  

Performance Rate 1-10                                      

1%                                      

Performance Rate 11-20

2%

Performance Rate 21-30

3%

Performance Rate 31-40

4%

Performance Rate 41-50

5%

Performance Rate 51-60

6%

Performance Rate 61-70

7%

Performance Rate 71-80

8%

Performance Rate 81-90

9%

Performance Rate 91-100

10%

As an example, if a clinician were to select the 2017 ACI Transition Measure Patient-Specific Education for a performance measure and submit a numerator/denominator of 850/1000, then that clinician would achieve an 85% performance rate for that measure, placing them into the Performance Rate 81-90 bracket with the potential to gain a 9% performance score on top of their base score.

Bonus Score
The ACI bonus score measures are optional but can contribute to up to 15% of the total ACI score. The bonus score includes the following measures:

  • Report to one or more additional public health and clinical data registries beyond the Immunization Registry Reporting measure (earn a 5% bonus).

    • Syndromic Surveillance Reporting: Per CMS, the MIPS eligible clinician must be in active engagement with a public health agency to submit syndromic surveillance data.

    • Specialized Registry Reporting: Per CMS, the MIPS eligible clinician must be in active engagement to submit data to a specialized registry.

  • Use CEHRT to complete certain improvement activities under the MIPS Improvement Activities performance category (earn a 10% bonus).

It is important to note that it is possible for a MIPS eligible clinician to earn the full 100% for the total ACI score without completing any bonus score measure activities.

Total ACI Performance Category Score Calculation

More information
You can visit Practice Fusion’s Quality Payment Program resource center here.

Further details regarding the MIPS program requirements can be found here.

CMS also provides further resources about the Quality Payment Program here.  

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